Provider Demographics
NPI:1720196660
Name:BIO-TECH MEDICAL SUPPLY
Entity Type:Organization
Organization Name:BIO-TECH MEDICAL SUPPLY
Other - Org Name:SAME AS ABOVE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JESTY
Authorized Official - Middle Name:MEPRATHU
Authorized Official - Last Name:VARUGHESE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-662-0887
Mailing Address - Street 1:PO BOX 851111
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75185-1111
Mailing Address - Country:US
Mailing Address - Phone:214-662-0887
Mailing Address - Fax:972-692-9920
Practice Address - Street 1:8035 E R L THORNTON FWY
Practice Address - Street 2:SUITE # 117
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75228-7018
Practice Address - Country:US
Practice Address - Phone:214-662-0887
Practice Address - Fax:972-692-9920
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX90059332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX184881401Medicaid
TX184881401Medicaid