=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144216896
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CADET MEDICAL SUPPLY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/27/2005
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 700 W HARWOOD RD SUITE E2
-----------------------------------------------------
City | HURST
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76054-3358
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-656-2690
-----------------------------------------------------
Fax | 888-233-4816
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 712
-----------------------------------------------------
City | BEDFORD
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76095-0712
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-656-2690
-----------------------------------------------------
Fax | 888-233-4861
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DANIEL MCKINLEY YANCY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 817-726-3910
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number | 0077082
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------