=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073291100
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SOCIAL MEDICAL SUPPLY, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/10/2023
-----------------------------------------------------
Last Update Date | 01/29/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2015 MCKENZIE DR STE 106
-----------------------------------------------------
City | CARROLLTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75006-8365
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-416-9009
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2015 MCKENZIE DR STE 106
-----------------------------------------------------
City | CARROLLTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75006-8365
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-416-9009
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | COO
-----------------------------------------------------
Name | MR. JAVIER BARRAGAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 917-731-2222
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------