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General NPI Number Information
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NPI Number | 1104849561
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Entity Type | Organization
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Legal Business Name | U S OSTOMY SUPPLY INC
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Dates
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Enumeration Date | 07/26/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2350 AIRPORT FWY SUITE #230
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City | BEDFORD
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State | TX
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Zip | 76022-6031
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Country | US
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Telephone | 817-354-9882
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Fax | 817-354-8076
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Provider Business Mailing Address
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Address Line | 2350 AIRPORT FWY SUITE #230
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City | BEDFORD
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State | TX
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Zip | 76022-6031
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Country | US
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Telephone | 817-354-9882
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Fax | 817-354-8076
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. MAHMOUD AMIN SIDDIG
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Credential |
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Telephone | 817-354-9882
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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 | 0088518
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License Number State | TX
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