Provider Demographics
NPI:1750483020
Name:HUCKS MEDICAL SUPPLY INC
Entity Type:Organization
Organization Name:HUCKS MEDICAL SUPPLY INC
Other - Org Name:EAST TEXAS HOME MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BRYCE
Authorized Official - Middle Name:EDWARDS
Authorized Official - Last Name:HAYES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-593-7715
Mailing Address - Street 1:524 E FRONT ST
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75702-8214
Mailing Address - Country:US
Mailing Address - Phone:903-593-7715
Mailing Address - Fax:903-561-1914
Practice Address - Street 1:524 E FRONT ST
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75702-8214
Practice Address - Country:US
Practice Address - Phone:903-593-7715
Practice Address - Fax:903-561-1914
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-05
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0081570OtherTX DEPT OF ST HEALTH SERV
TX156774502Medicaid
TX0081570OtherTX DEPT OF ST HEALTH SERV