Provider Demographics
NPI:1295766244
Name:MSB, INC.
Entity type:Organization
Organization Name:MSB, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:GODFREY
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:817-335-5810
Mailing Address - Street 1:707 NORTH FWY
Mailing Address - Street 2:SUITE 114
Mailing Address - City:FT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76102-1702
Mailing Address - Country:US
Mailing Address - Phone:817-335-5810
Mailing Address - Fax:817-335-5920
Practice Address - Street 1:707 NORTH FWY
Practice Address - Street 2:SUITE 114
Practice Address - City:FT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76102-1702
Practice Address - Country:US
Practice Address - Phone:817-335-5810
Practice Address - Fax:817-335-5920
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2010-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX011539601Medicaid
TX011539601Medicaid