Healthcare Provider Details

I. General information

NPI: 1841487774
Provider Name (Legal Business Name): S.M.A. MEDICAL SUPPLY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2007
Last Update Date: 09/25/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

613 COIT RD
PLANO TX
75075-5704
US

IV. Provider business mailing address

18012 CARROLLWOOD DR
DALLAS TX
75252-6330
US

V. Phone/Fax

Practice location:
  • Phone: 269-274-1414
  • Fax: 972-407-9232
Mailing address:
  • Phone: 269-274-1414
  • Fax: 972-407-9232

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number0099324
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number0099324
License Number StateTX

VIII. Authorized Official

Name: DANA CRAVEN
Title or Position: OWNER
Credential:
Phone: 269-274-1414