Provider Demographics
NPI:1184403818
Name:SCISSOR TAIL ENTERPRISES LLC DBA SCISSORTAIL MEDICAL SUPPLY
Entity type:Organization
Organization Name:SCISSOR TAIL ENTERPRISES LLC DBA SCISSORTAIL MEDICAL SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JOE
Authorized Official - Last Name:GENTRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-203-7922
Mailing Address - Street 1:133 SADDLE BROOK CIR
Mailing Address - Street 2:
Mailing Address - City:HALLSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75650-7722
Mailing Address - Country:US
Mailing Address - Phone:903-203-7922
Mailing Address - Fax:
Practice Address - Street 1:5899 HWY 80 EAST
Practice Address - Street 2:BUILDING A SUITE 3
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75605-6837
Practice Address - Country:US
Practice Address - Phone:903-660-5097
Practice Address - Fax:903-660-5131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-22
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1003219OtherMEDICAL DEVICE DISTRIBUTOR