Provider Demographics
NPI:1710606801
Name:MIDLAND MEDICAL SUPPLY LLC
Entity Type:Organization
Organization Name:MIDLAND MEDICAL SUPPLY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:BREEDWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-270-5044
Mailing Address - Street 1:2215 N MIDLAND DR STE 4C-2
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79707-5561
Mailing Address - Country:US
Mailing Address - Phone:432-789-2210
Mailing Address - Fax:432-445-7872
Practice Address - Street 1:2215 N MIDLAND DR STE 4C-2
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79707-5561
Practice Address - Country:US
Practice Address - Phone:432-789-2210
Practice Address - Fax:432-445-7872
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-23
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies