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General NPI Number Information
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NPI Number | 1033490578
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Entity Type | Organization
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Legal Business Name | MEDHAB
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Dates
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Enumeration Date | 08/29/2011
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Last Update Date | 02/07/2013
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Provider Practice Location Address
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Address Line | 2009 W BEAUREGARD AVE
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City | SAN ANGELO
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State | TX
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Zip | 76901-3812
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Country | US
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Telephone | 817-233-5271
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Fax |
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Provider Business Mailing Address
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Address Line | 1120 SOUTH FWY SUITE 105
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City | FORT WORTH
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State | TX
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Zip | 76104-5064
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Country | US
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Telephone | 817-233-5271
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Fax |
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | MR. JOHNNY ROSS JR.
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Credential |
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Telephone | 817-233-5271
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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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Taxonomy #2
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Taxonomy Code | 332BN1400X
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Taxonomy Name | Nursing Facility Supplies (DME)
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number |
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License Number State |
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