Healthcare Provider Details

I. General information

NPI: 1427288448
Provider Name (Legal Business Name): CIPAN MEDICAL SUPPLY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2009
Last Update Date: 11/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

818 S CENTRAL EXPY STE 4
RICHARDSON TX
75080-7306
US

IV. Provider business mailing address

818 S CENTRAL EXPY STE 4
RICHARDSON TX
75080-7306
US

V. Phone/Fax

Practice location:
  • Phone: 972-699-8400
  • Fax: 972-699-8408
Mailing address:
  • Phone: 972-699-8400
  • Fax: 972-699-8408

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number1000123
License Number StateTX

VIII. Authorized Official

Name: CHINYELU NNAKE
Title or Position: OWNER
Credential:
Phone: 972-699-8400