Provider Demographics
NPI:1710024831
Name:TEXAS BLUE BONNET DURABLE MEDICAL EQUIPMENT CONPANY INC.
Entity Type:Organization
Organization Name:TEXAS BLUE BONNET DURABLE MEDICAL EQUIPMENT CONPANY INC.
Other - Org Name:TEXAS BLUE BONNET DME
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:M
Authorized Official - Last Name:FETTINGER
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:817-275-1040
Mailing Address - Street 1:808 UTILITY
Mailing Address - Street 2:
Mailing Address - City:SANGER
Mailing Address - State:TX
Mailing Address - Zip Code:76266
Mailing Address - Country:US
Mailing Address - Phone:940-458-9172
Mailing Address - Fax:
Practice Address - Street 1:808 UTILITY
Practice Address - Street 2:
Practice Address - City:SANGER
Practice Address - State:TX
Practice Address - Zip Code:76266
Practice Address - Country:US
Practice Address - Phone:940-458-9172
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2007-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX332B00000X, 332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies