Provider Demographics
NPI:1689794026
Name:MED CARE MEDICAL SUPPLY OF NO.TX INC
Entity Type:Organization
Organization Name:MED CARE MEDICAL SUPPLY OF NO.TX INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCIAL MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:EDITH
Authorized Official - Middle Name:HUDSON
Authorized Official - Last Name:DOOLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:940-549-9797
Mailing Address - Street 1:1005 HWY 16 S
Mailing Address - Street 2:
Mailing Address - City:GRAHAM
Mailing Address - State:TX
Mailing Address - Zip Code:76450
Mailing Address - Country:US
Mailing Address - Phone:940-549-9797
Mailing Address - Fax:940-549-9797
Practice Address - Street 1:3402 W WALKER ST
Practice Address - Street 2:
Practice Address - City:BRECKENRIDGE
Practice Address - State:TX
Practice Address - Zip Code:76424-3911
Practice Address - Country:US
Practice Address - Phone:254-559-1500
Practice Address - Fax:254-559-1010
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MED CARE MEDICAL SUPPLY OF NO. TX INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-30
Last Update Date:2010-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0057067332B00000X
TX93470332B00000X
TX372690332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0857580003Medicare UPIN
TX0857580003Medicare NSC