Provider Demographics
NPI:1790952679
Name:SAR MEDICAL SUPPLY INC
Entity Type:Organization
Organization Name:SAR MEDICAL SUPPLY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AYO
Authorized Official - Middle Name:O
Authorized Official - Last Name:OGUNDELE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:214-357-8100
Mailing Address - Street 1:2351 W NORTHWEST HWY
Mailing Address - Street 2:SUITE 3245
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75220-4433
Mailing Address - Country:US
Mailing Address - Phone:214-357-8100
Mailing Address - Fax:214-594-6894
Practice Address - Street 1:2351 W NORTHWEST HWY
Practice Address - Street 2:SUITE 3245
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75220-4433
Practice Address - Country:US
Practice Address - Phone:214-357-8100
Practice Address - Fax:214-594-6894
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SAR MEDICAL SUPPLY INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-05-10
Last Update Date:2011-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0102081332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2119018-02Medicaid
TX2119018-01Medicaid
6278530001Medicare NSC