Provider Demographics
NPI:1811227721
Name:TOP SOURCE MEDICAL SUPPLIES & EQUIPMENTS
Entity Type:Organization
Organization Name:TOP SOURCE MEDICAL SUPPLIES & EQUIPMENTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CLEMENTINA
Authorized Official - Middle Name:N
Authorized Official - Last Name:OKOYE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-340-1112
Mailing Address - Street 1:9550 FOREST LN
Mailing Address - Street 2:STE. 108
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-5991
Mailing Address - Country:US
Mailing Address - Phone:214-340-1112
Mailing Address - Fax:214-221-9195
Practice Address - Street 1:9550 FOREST LN
Practice Address - Street 2:STE. 108
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-5991
Practice Address - Country:US
Practice Address - Phone:214-340-1112
Practice Address - Fax:214-221-9195
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TOP SOURCE MEDICAL SUPPLIES & EQUIPMENTS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-12-28
Last Update Date:2011-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1000183332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX6468940001Medicare NSC