Provider Demographics
NPI:1801073705
Name:HEAVENLY ANGELS DURABLE MEDICAL SUPPLIES
Entity type:Organization
Organization Name:HEAVENLY ANGELS DURABLE MEDICAL SUPPLIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANGEL
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:REED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:979-823-5200
Mailing Address - Street 1:1706 E 29TH ST
Mailing Address - Street 2:STE. 103
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77802-1425
Mailing Address - Country:US
Mailing Address - Phone:979-823-5200
Mailing Address - Fax:
Practice Address - Street 1:1706 E 29TH ST
Practice Address - Street 2:STE. 103
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-1425
Practice Address - Country:US
Practice Address - Phone:979-823-5200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-23
Last Update Date:2008-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0089725332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX183214901Medicaid
TX5731100001Medicare NSC