Healthcare Provider Details

I. General information

NPI: 1447232442
Provider Name (Legal Business Name): MANGOLD MEMORIAL HOME MEDICAL EQUIPMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

214 N MAIN
LOCKNEY TX
79241
US

IV. Provider business mailing address

214 N MAIN
LOCKNEY TX
79241
US

V. Phone/Fax

Practice location:
  • Phone: 806-652-2834
  • Fax: 806-652-2836
Mailing address:
  • Phone: 806-652-2834
  • Fax: 806-652-2836

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: SHARON HUNT
Title or Position: ADMINISTRATOR
Credential:
Phone: 806-652-2834