Healthcare Provider Details

I. General information

NPI: 1497719769
Provider Name (Legal Business Name): MELINDA'S MEDICAL SUPPLY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2006
Last Update Date: 10/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 E 32ND ST
SILVER CITY NM
88061-7205
US

IV. Provider business mailing address

910 E 32ND ST
SILVER CITY NM
88061-7205
US

V. Phone/Fax

Practice location:
  • Phone: 575-534-4013
  • Fax: 575-534-4016
Mailing address:
  • Phone: 575-534-4013
  • Fax: 575-534-4016

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number02-376273-00 0
License Number StateNM

VIII. Authorized Official

Name: MRS. MELINDA BARTLETT
Title or Position: OWNER
Credential:
Phone: 575-534-4013