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General NPI Number Information
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NPI Number | 1144438086
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Entity Type | Organization
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Legal Business Name | BRAZOS VALLEY MEDICAL EQUIPMENT, INC.
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Dates
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Enumeration Date | 05/21/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2644 DERBY LN
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City | MADISONVILLE
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State | TX
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Zip | 77864-4110
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Country | US
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Telephone | 936-348-5709
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Fax | 936-348-5358
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Provider Business Mailing Address
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Address Line | 2644 DERBY LN
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City | MADISONVILLE
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State | TX
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Zip | 77864-4110
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Country | US
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Telephone | 936-348-5709
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Fax | 936-348-5358
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Authorized Official
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Title or Position | VICEPRESIDENTANDMANAGER
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Name | MRS. PATRICIA ANN CHENNAULT
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Credential |
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Telephone | 936-348-5709
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BX2000X
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Taxonomy Name | Oxygen Equipment & Supplies (DME)
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License Number | 0041089
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License Number State | TX
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