Healthcare Provider Details

I. General information

NPI: 1669074571
Provider Name (Legal Business Name): HAYS MEDICAL SUPPLY LLC JUDSON STURDIVANT SOLE MBR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2020
Last Update Date: 11/16/2020
Certification Date: 11/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5508 PARKCREST DR STE 310
AUSTIN TX
78731-4915
US

IV. Provider business mailing address

5508 PARKCREST DR STE 310
AUSTIN TX
78731-4915
US

V. Phone/Fax

Practice location:
  • Phone: 512-697-9896
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: JUDSON STURDIVANT
Title or Position: CEO
Credential:
Phone: 512-697-9896