Healthcare Provider Details

I. General information

NPI: 1710024831
Provider Name (Legal Business Name): TEXAS BLUE BONNET DURABLE MEDICAL EQUIPMENT CONPANY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 09/18/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

808 UTILITY
SANGER TX
76266
US

IV. Provider business mailing address

808 UTILITY
SANGER TX
76266
US

V. Phone/Fax

Practice location:
  • Phone: 940-458-9172
  • Fax:
Mailing address:
  • Phone: 940-458-9172
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number StateTX

VIII. Authorized Official

Name: MR. GEORGE M FETTINGER
Title or Position: CEO
Credential: CPA
Phone: 817-275-1040