Healthcare Provider Details

I. General information

NPI: 1669336434
Provider Name (Legal Business Name): BRACEWELL MEDICAL SUPPLY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5473 BLAIR RD STE 434097
DALLAS TX
75231-4226
US

IV. Provider business mailing address

1442 POTTSTOWN PIKE STE 272
WEST CHESTER PA
19380-1271
US

V. Phone/Fax

Practice location:
  • Phone: 610-255-7800
  • Fax: 610-255-7800
Mailing address:
  • Phone: 610-255-7800
  • Fax: 610-255-7800

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: NELSON LAMIZANA
Title or Position: OWNER
Credential:
Phone: 610-255-7800