Provider Demographics
NPI:1477237873
Name:WISE OWL MEDICAL SUPPLY LLC
Entity type:Organization
Organization Name:WISE OWL MEDICAL SUPPLY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CASEY
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:830-990-4775
Mailing Address - Street 1:3409 N US HIGHWAY 281
Mailing Address - Street 2:
Mailing Address - City:MARBLE FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:78654-3824
Mailing Address - Country:US
Mailing Address - Phone:830-637-7772
Mailing Address - Fax:830-637-7773
Practice Address - Street 1:3409 N US HIGHWAY 281
Practice Address - Street 2:
Practice Address - City:MARBLE FALLS
Practice Address - State:TX
Practice Address - Zip Code:78654-3824
Practice Address - Country:US
Practice Address - Phone:830-637-7772
Practice Address - Fax:830-637-7773
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-14
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies