Healthcare Provider Details

I. General information

NPI: 1720280902
Provider Name (Legal Business Name): THE EDDICK CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2007
Last Update Date: 10/02/2020
Certification Date: 10/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1015 HILLCREST DR SUITE B
VERNON TX
76384-3194
US

IV. Provider business mailing address

1015 HILLCREST DR SUITE B
VERNON TX
76384-3194
US

V. Phone/Fax

Practice location:
  • Phone: 940-553-4361
  • Fax: 940-552-2075
Mailing address:
  • Phone: 940-552-9501
  • Fax: 940-552-2075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number05013
License Number StateTX

VIII. Authorized Official

Name: DR. ADAM SCOTT BAYER
Title or Position: OWNER PHARMACIST
Credential: PHARMD
Phone: 940-552-9501