Provider Demographics
NPI:1689810442
Name:JUSTINA N EKWOROMADU
Entity Type:Organization
Organization Name:JUSTINA N EKWOROMADU
Other - Org Name:FIRST CARE MEDICAL SUPPLY COMPANY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER/ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JUSTINA
Authorized Official - Middle Name:E
Authorized Official - Last Name:EKWOROMADU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-503-7415
Mailing Address - Street 1:9696 SKILLMAN ST
Mailing Address - Street 2:SUITE 265
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-8264
Mailing Address - Country:US
Mailing Address - Phone:214-503-7415
Mailing Address - Fax:214-503-7451
Practice Address - Street 1:9696 SKILLMAN ST
Practice Address - Street 2:SUITE 265
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-8264
Practice Address - Country:US
Practice Address - Phone:214-503-7415
Practice Address - Fax:214-503-7451
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-29
Last Update Date:2011-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0108079332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX6332350001Medicare NSC