Provider Demographics
NPI:1750749354
Name:CENTURION DISTRIBUTORS, LLC
Entity type:Organization
Organization Name:CENTURION DISTRIBUTORS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TANNER
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-933-4764
Mailing Address - Street 1:2600 WHITNEY DR
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79705-6243
Mailing Address - Country:US
Mailing Address - Phone:505-933-4764
Mailing Address - Fax:432-247-1101
Practice Address - Street 1:2600 WHITNEY DR
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79705-6243
Practice Address - Country:US
Practice Address - Phone:505-933-4764
Practice Address - Fax:432-247-1101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-10
Last Update Date:2016-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies