=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255734158
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BASSWOOD DURABLE MEDICAL EQUIPMENT
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/06/2014
-----------------------------------------------------
Last Update Date | 10/06/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1001 E HEBRON PKWY SUITE 118-106
-----------------------------------------------------
City | CARROLLTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75010-1002
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 877-974-6467
-----------------------------------------------------
Fax | 877-958-7837
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1001 E HEBRON PKWY SUITE 118-106
-----------------------------------------------------
City | CARROLLTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75010-1002
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 877-974-6467
-----------------------------------------------------
Fax | 877-958-7837
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | EDWARD TANG
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 877-974-6467
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------