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General NPI Number Information
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NPI Number | 1043450257
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Entity Type | Organization
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Legal Business Name | WHITE MATTRESS CO.
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Dates
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Enumeration Date | 02/27/2009
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Last Update Date | 02/27/2009
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Provider Practice Location Address
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Address Line | 1010 S MAIN ST SUITE 2
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City | ROSWELL
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State | NM
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Zip | 88203-5634
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Country | US
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Telephone | 575-624-1000
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Fax | 575-623-2000
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Provider Business Mailing Address
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Address Line | 1010 S MAIN ST SUITE 2
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City | ROSWELL
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State | NM
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Zip | 88203-5634
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Country | US
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Telephone | 575-624-1000
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Fax | 575-623-2000
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Authorized Official
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Title or Position | PROPRIETOR
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Name | MR. DAREL D. DEVENPORT
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Credential |
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Telephone | 575-624-1000
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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 | 01-134826-00-7
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License Number State | NM
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