Healthcare Provider Details

I. General information

NPI: 1427093012
Provider Name (Legal Business Name): EAGLE MEDICAL EQUIPMENT & SUPPLY CO.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2006
Last Update Date: 01/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9304 FOREST LN #238
DALLAS TX
75243-6238
US

IV. Provider business mailing address

9304 FOREST LN #238
DALLAS TX
75243-6238
US

V. Phone/Fax

Practice location:
  • Phone: 214-342-6100
  • Fax: 214-342-6101
Mailing address:
  • Phone: 214-342-6100
  • Fax: 214-342-6101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number0101641
License Number StateTX

VIII. Authorized Official

Name: UCHE E. NWABUNWANNE
Title or Position: CHIEF OPERATING OFFICER/OWNER
Credential:
Phone: 214-342-6100