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General NPI Number Information
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NPI Number | 1023464245
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Entity Type | Organization
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Legal Business Name | EMEDTECH EQUIPMENT AND SUPPLY COMPANY
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Dates
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Enumeration Date | 05/05/2016
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Last Update Date | 05/05/2016
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Provider Practice Location Address
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Address Line | 5220 E PARKWAY DR
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City | BEAUMONT
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State | TX
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Zip | 77705-6039
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Country | US
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Telephone | 409-201-4706
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 6391
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City | BEAUMONT
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State | TX
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Zip | 77725-0391
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO/FOUNDER
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Name | MR. ALFRED CHARLES POULLARD
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Credential |
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Telephone | 409-201-4706
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320700000X
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Taxonomy Name | Physical Disabilities Residential Treatment Facility
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License Number |
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License Number State | TX
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