Healthcare Provider Details

I. General information

NPI: 1881630762
Provider Name (Legal Business Name): MEDIGY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2006
Last Update Date: 01/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1822 N SYLVANIA AVE
FORT WORTH TX
76111-2755
US

IV. Provider business mailing address

1822 N SYLVANIA AVE
FORT WORTH TX
76111-2755
US

V. Phone/Fax

Practice location:
  • Phone: 817-379-6334
  • Fax: 817-379-6335
Mailing address:
  • Phone: 817-379-6334
  • Fax: 817-379-6335

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number0075939
License Number StateTX

VIII. Authorized Official

Name: KEN HARDING
Title or Position: CEO
Credential:
Phone: 817-379-6334