=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043027832
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FORT GARRISON PROCUREMENT COMPANY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/16/2024
-----------------------------------------------------
Last Update Date | 12/16/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3302 VILLAGE POND LN
-----------------------------------------------------
City | FRESNO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77545-8782
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 312-619-6515
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3302 VILLAGE POND LN
-----------------------------------------------------
City | FRESNO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77545-8782
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 312-619-6515
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | TROY P MILLER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 281-961-3585
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332BN1400X
-----------------------------------------------------
Taxonomy Name | Nursing Facility Supplies (DME)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------