Provider Demographics
NPI:1821171893
Name:COLONIAL MEDICAL SUPPLY COMPANY
Entity Type:Organization
Organization Name:COLONIAL MEDICAL SUPPLY COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:NKWONTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-864-5667
Mailing Address - Street 1:3433 W KINGSLEY RD STE 9
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75041-2223
Mailing Address - Country:US
Mailing Address - Phone:972-864-5667
Mailing Address - Fax:
Practice Address - Street 1:3433 W KINGSLEY RD STE 9
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75041-2223
Practice Address - Country:US
Practice Address - Phone:972-864-5667
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0066537332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX4739060001Medicare NSC