Healthcare Provider Details

I. General information

NPI: 1801540596
Provider Name (Legal Business Name): 3 C HEALTHCARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2022
Last Update Date: 10/07/2022
Certification Date: 10/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 BUNTON CREEK RD UNIT 100B
KYLE TX
78640-2778
US

IV. Provider business mailing address

PO BOX 130008
TYLER TX
75713-0008
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 Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State

VIII. Authorized Official

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