Provider Demographics
NPI:1740367531
Name:SUPPORT MEDICAL COMPANY
Entity type:Organization
Organization Name:SUPPORT MEDICAL COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES./CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:SHELBY
Authorized Official - Middle Name:
Authorized Official - Last Name:STAGGS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-792-9770
Mailing Address - Street 1:4821 34TH ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79410-2421
Mailing Address - Country:US
Mailing Address - Phone:806-792-9770
Mailing Address - Fax:806-792-9774
Practice Address - Street 1:4821 34TH ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79410-2421
Practice Address - Country:US
Practice Address - Phone:806-792-9770
Practice Address - Fax:806-792-9774
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NOT APPLICABLE332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0581190001Medicare ID - Type Unspecified