Provider Demographics
NPI:1720280902
Name:THE EDDICK CORPORATION
Entity Type:Organization
Organization Name:THE EDDICK CORPORATION
Other - Org Name:HILLCREST PHARMACY AND MEDICAL EQUIPMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER PHARMACIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:BAYER
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:940-552-9501
Mailing Address - Street 1:1015 HILLCREST DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:VERNON
Mailing Address - State:TX
Mailing Address - Zip Code:76384-3194
Mailing Address - Country:US
Mailing Address - Phone:940-552-9501
Mailing Address - Fax:940-552-2075
Practice Address - Street 1:1015 HILLCREST DR
Practice Address - Street 2:SUITE B
Practice Address - City:VERNON
Practice Address - State:TX
Practice Address - Zip Code:76384-3194
Practice Address - Country:US
Practice Address - Phone:940-553-4361
Practice Address - Fax:940-552-2075
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-01
Last Update Date:2020-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 332BX2000X
TX05013333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX091438401Medicaid
TX0457610001Medicare ID - Type Unspecified