=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144259904
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TANGLEWOOD MEDICAL SUPPLIES, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/02/2006
-----------------------------------------------------
Last Update Date | 01/13/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5940 LOWER BIRDVILLE RD UNIT B3
-----------------------------------------------------
City | HALTOM CITY
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76117-5708
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-244-1105
-----------------------------------------------------
Fax | 254-968-6167
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2445 ROBERT J GLASGOW LOOP STE B
-----------------------------------------------------
City | STEPHENVILLE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76401-1705
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 254-968-6999
-----------------------------------------------------
Fax | 254-968-6167
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | EDMUND CASE HORTON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 254-968-6999
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332BC3200X
-----------------------------------------------------
Taxonomy Name | Customized Equipment (DME)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 332BP3500X
-----------------------------------------------------
Taxonomy Name | Parenteral & Enteral Nutrition Supplies (DME)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 332BX2000X
-----------------------------------------------------
Taxonomy Name | Oxygen Equipment & Supplies (DME)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------