Provider Demographics
NPI:1760008791
Name:EAST MEDICAL LLC
Entity Type:Organization
Organization Name:EAST MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLER
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:FULLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-395-8402
Mailing Address - Street 1:401 CONGRESS AVE STE 1540
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78701-3851
Mailing Address - Country:US
Mailing Address - Phone:214-770-2611
Mailing Address - Fax:
Practice Address - Street 1:401 CONGRESS AVE STE 1540
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78701-3851
Practice Address - Country:US
Practice Address - Phone:214-770-2611
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-25
Last Update Date:2020-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies