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General NPI Number Information
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NPI Number | 1033360490
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Entity Type | Organization
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Legal Business Name | PROVIDACARE MEDICAL SUPPLY LTD
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Dates
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Enumeration Date | 10/03/2008
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Last Update Date | 08/30/2010
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Provider Practice Location Address
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Address Line | 1300 HWY 281
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City | MARBLE FALLS
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State | TX
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Zip | 78654-4504
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Country | US
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Telephone | 830-693-7313
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Fax | 830-693-7363
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Provider Business Mailing Address
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Address Line | 3721 EXECUTIVE CENTER DR SUITE 102
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City | AUSTIN
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State | TX
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Zip | 78731-1645
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Country | US
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Telephone | 512-733-6518
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Fax | 512-795-9185
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Authorized Official
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Title or Position | CEO
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Name | MR. RYAN N BENNETT
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Credential |
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Telephone | 512-733-6518
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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