Provider Demographics
NPI:1760419683
Name:MEDLES ENTERPRISES LLC
Entity Type:Organization
Organization Name:MEDLES ENTERPRISES LLC
Other - Org Name:MEDLES MEDICAL SUPPLY CO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/MANAGING MEMBER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LEZLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BALENTINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-463-0303
Mailing Address - Street 1:2806 LAWING LN
Mailing Address - Street 2:STE B
Mailing Address - City:ROWLETT
Mailing Address - State:TX
Mailing Address - Zip Code:75088-7553
Mailing Address - Country:US
Mailing Address - Phone:972-463-0303
Mailing Address - Fax:972-463-8383
Practice Address - Street 1:2806 LAWING LN
Practice Address - Street 2:STE B
Practice Address - City:ROWLETT
Practice Address - State:TX
Practice Address - Zip Code:75088-7553
Practice Address - Country:US
Practice Address - Phone:972-463-0303
Practice Address - Fax:972-463-8383
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX5618670001Medicare NSC