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General NPI Number Information
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NPI Number | 1104065762
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Entity Type | Organization
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Legal Business Name | MEDSTAR ORTHOPEDIC SUPPLIES, LLC
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Dates
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Enumeration Date | 02/05/2009
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Last Update Date | 02/05/2009
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Provider Practice Location Address
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Address Line | 8150 N CENTRAL EXPY STE 930
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City | DALLAS
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State | TX
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Zip | 75206-1827
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Country | US
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Telephone | 214-587-3760
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Fax |
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Provider Business Mailing Address
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Address Line | 2300 MCDERMOTT RD STE 200-199
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City | PLANO
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State | TX
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Zip | 75025-7016
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Country | US
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Telephone | 214-587-3760
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Fax |
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Authorized Official
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Title or Position | PRINCIPAL
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Name | GREG YOUNG
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Credential |
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Telephone | 214-587-3760
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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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