Provider Demographics
NPI:1740425933
Name:3 C HEALTHCARE, LLC
Entity Type:Organization
Organization Name:3 C HEALTHCARE, LLC
Other - Org Name:WEAVER HOME MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JUDSON
Authorized Official - Middle Name:
Authorized Official - Last Name:STURDIVANT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-697-9896
Mailing Address - Street 1:PO BOX 130008
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75713-0008
Mailing Address - Country:US
Mailing Address - Phone:512-697-9896
Mailing Address - Fax:
Practice Address - Street 1:3700 WESTWAY ST
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703-6464
Practice Address - Country:US
Practice Address - Phone:903-597-4363
Practice Address - Fax:903-526-7617
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-03
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0107831332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX6280910001Medicare NSC