Healthcare Provider Details

I. General information

NPI: 1992092092
Provider Name (Legal Business Name): CIDEL MEDICAL SUPPLIES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2011
Last Update Date: 02/14/2024
Certification Date: 02/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

804 W SHORE DR SUITE 11
RICHARDSON TX
75080-5047
US

IV. Provider business mailing address

804 W SHORE DR SUITE 11
RICHARDSON TX
75080-5047
US

V. Phone/Fax

Practice location:
  • Phone: 972-801-7454
  • Fax:
Mailing address:
  • Phone: 972-801-7454
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number1000565
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332BN1400X
TaxonomyNursing Facility Supplies (DME)
License Number1000565
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number1000565
License Number StateTX

VIII. Authorized Official

Name: MR. EMMANUEL IKE IFEJI
Title or Position: C.E.O
Credential:
Phone: 972-801-7454