Provider Demographics
NPI:1891975082
Name:LANDMARK MEDICAL, INC.
Entity Type:Organization
Organization Name:LANDMARK MEDICAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:CRAIG
Authorized Official - Last Name:ANCINEC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-297-7669
Mailing Address - Street 1:3549 GILMER RD STE D
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75604-1259
Mailing Address - Country:US
Mailing Address - Phone:903-297-7669
Mailing Address - Fax:903-297-4873
Practice Address - Street 1:3549 GILMER RD STE D
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75604-1259
Practice Address - Country:US
Practice Address - Phone:903-297-7669
Practice Address - Fax:903-297-4873
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-06
Last Update Date:2010-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX010762501Medicaid
TX016591201Medicaid
TX1211530001Medicare NSC