Provider Demographics
NPI:1952594368
Name:SIKUTWA MEDICAL SUPPLY
Entity type:Organization
Organization Name:SIKUTWA MEDICAL SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:
Authorized Official - Last Name:SIKUTWA
Authorized Official - Suffix:II
Authorized Official - Credentials:
Authorized Official - Phone:972-235-6108
Mailing Address - Street 1:7557 RAMBLER RD
Mailing Address - Street 2:STE 700
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-4142
Mailing Address - Country:US
Mailing Address - Phone:972-235-6108
Mailing Address - Fax:972-437-3157
Practice Address - Street 1:7557 RAMBLER RD
Practice Address - Street 2:STE 700
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-4142
Practice Address - Country:US
Practice Address - Phone:972-235-6108
Practice Address - Fax:972-437-3157
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-20
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0082334332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX5486600001Medicare NSC