Healthcare Provider Details

I. General information

NPI: 1568616092
Provider Name (Legal Business Name): BEBE MED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/11/2008
Last Update Date: 11/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 MELODY LN
HICKORY CREEK TX
75065-7574
US

IV. Provider business mailing address

105 MELODY LN
HICKORY CREEK TX
75065-7574
US

V. Phone/Fax

Practice location:
  • Phone: 940-326-9727
  • Fax: 940-326-9730
Mailing address:
  • Phone: 940-326-9727
  • Fax: 940-326-9730

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number StateTX

VIII. Authorized Official

Name: ROBIN DAWN SMITH
Title or Position: PRESIDENT
Credential:
Phone: 469-464-6006