Healthcare Provider Details

I. General information

NPI: 1548205313
Provider Name (Legal Business Name): EDDIE ETTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2006
Last Update Date: 09/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

705 E ABRAM ST SUITE 100
ARLINGTON TX
76010-1240
US

IV. Provider business mailing address

705 E ABRAM ST SUITE 100
ARLINGTON TX
76010-1240
US

V. Phone/Fax

Practice location:
  • Phone: 817-200-2363
  • Fax: 817-200-2356
Mailing address:
  • Phone: 817-200-2363
  • Fax: 817-200-2356

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number0063143
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number332B00000X
License Number StateTX

VIII. Authorized Official

Name: MR. EDDIE ETTE
Title or Position: BUSINESS OWNER
Credential:
Phone: 817-200-2363