Healthcare Provider Details

I. General information

NPI: 1801076518
Provider Name (Legal Business Name): HAASTADE MEDICAL SUPPLY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2007
Last Update Date: 11/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

811 S CENTRAL EXPY SUITE 536
RICHARDSON TX
75080-7415
US

IV. Provider business mailing address

811 S CENTRAL EXPY SUITE 536
RICHARDSON TX
75080-7415
US

V. Phone/Fax

Practice location:
  • Phone: 972-235-8383
  • Fax: 972-235-8384
Mailing address:
  • Phone: 972-235-8383
  • Fax: 972-235-8384

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number0083557
License Number StateTX

VIII. Authorized Official

Name: MRS. ADESHOLA OYENUGA
Title or Position: CEO
Credential:
Phone: 972-235-8383