Provider Demographics
NPI:1659986578
Name:ARCHER-ROSE, LLC
Entity Type:Organization
Organization Name:ARCHER-ROSE, LLC
Other - Org Name:WISE OWL MEDICAL SUPPLY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CASEY
Authorized Official - Middle Name:SLAY
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:830-990-4775
Mailing Address - Street 1:1408 E MAIN ST STE 200
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78624-5376
Mailing Address - Country:US
Mailing Address - Phone:830-990-4775
Mailing Address - Fax:
Practice Address - Street 1:3409 N US HIGHWAY 281
Practice Address - Street 2:
Practice Address - City:MARBLE FALLS
Practice Address - State:TX
Practice Address - Zip Code:78654-3824
Practice Address - Country:US
Practice Address - Phone:830-637-7772
Practice Address - Fax:830-637-7773
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ARCHER-ROSE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-09-09
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies