Provider Demographics
NPI:1851483325
Name:MEDICAL EXPRESS DEPOT, INC.
Entity Type:Organization
Organization Name:MEDICAL EXPRESS DEPOT, INC.
Other - Org Name:CCS MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:HOFMEISTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-628-2100
Mailing Address - Street 1:3030 LBJ FWY STE 1525
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75234-7758
Mailing Address - Country:US
Mailing Address - Phone:972-628-2100
Mailing Address - Fax:
Practice Address - Street 1:10475 PERRY HWY STE 102G
Practice Address - Street 2:
Practice Address - City:WEXFORD
Practice Address - State:PA
Practice Address - Zip Code:15090-9213
Practice Address - Country:US
Practice Address - Phone:800-599-7521
Practice Address - Fax:724-940-1981
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-29
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA6000006454332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0014612090004Medicaid
RI1851483325Medicaid