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General NPI Number Information
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NPI Number | 1255323671
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Entity Type | Organization
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Legal Business Name | ROOSTER MEDICAL EQUIPMENT & SUPPLIES
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Dates
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Enumeration Date | 08/22/2005
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 3000 SANDAGE AVE 109
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City | FORT WORTH
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State | TX
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Zip | 76109-1768
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Country | US
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Telephone | 817-923-1900
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Fax | 817-923-1952
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Provider Business Mailing Address
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Address Line | 3000 SANDAGE AVE 109
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City | FORT WORTH
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State | TX
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Zip | 76109-1768
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Country | US
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Telephone | 817-923-1900
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Fax | 817-923-1952
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Authorized Official
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Title or Position | OWNER
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Name | B J EKANEM
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Credential |
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Telephone | 817-923-1900
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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 | 0060761
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 332BP3500X
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Taxonomy Name | Parenteral & Enteral Nutrition Supplies (DME)
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License Number | 0060761
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License Number State | TX
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