Provider Demographics
NPI:1699846816
Name:ADA EQUIPMENT & SUPPLIES
Entity Type:Organization
Organization Name:ADA EQUIPMENT & SUPPLIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JESSE
Authorized Official - Middle Name:
Authorized Official - Last Name:MIRANDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-442-8681
Mailing Address - Street 1:1714 FORTVIEW RD STE 106D
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-7659
Mailing Address - Country:US
Mailing Address - Phone:512-517-8680
Mailing Address - Fax:512-442-8681
Practice Address - Street 1:1714 FORTVIEW RD STE 106D
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-7659
Practice Address - Country:US
Practice Address - Phone:512-517-8680
Practice Address - Fax:512-442-8681
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-10
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0092593332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies