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General NPI Number Information
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NPI Number | 1093998916
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Entity Type | Organization
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Legal Business Name | OPEN-HEAVEN MEDICAL SUPPLY LLC
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Dates
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Enumeration Date | 12/13/2007
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Last Update Date | 06/23/2008
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Provider Practice Location Address
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Address Line | 860 HEBRON PKWY SUITE 502
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City | LEWISVILLE
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State | TX
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Zip | 75057-5003
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Country | US
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Telephone | 972-459-5555
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Fax |
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Provider Business Mailing Address
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Address Line | 860 HEBRON PKWY SUITE 502
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City | LEWISVILLE
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State | TX
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Zip | 75057-5003
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Country | US
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Telephone | 972-459-5555
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | PAUL OLALEKAN AMOSUN
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Credential |
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Telephone | 972-459-5555
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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 | N/A
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License Number State |
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Taxonomy #2
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Taxonomy Code | 332BX2000X
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Taxonomy Name | Oxygen Equipment & Supplies (DME)
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License Number | 6043840001
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License Number State | TX
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