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General NPI Number Information
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NPI Number | 1275116741
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Entity Type | Organization
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Legal Business Name | MINERAL WELLS MEDICAL SUPPLY, INC.
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Dates
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Enumeration Date | 05/03/2021
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Last Update Date | 10/15/2021
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Provider Practice Location Address
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Address Line | 1706 STATE HIGHWAY 16 S
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City | GRAHAM
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State | TX
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Zip | 76450-4606
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Country | US
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Telephone | 940-452-1986
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1152
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City | MINERAL WELLS
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State | TX
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Zip | 76068-1152
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Country | US
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Telephone | 940-521-9460
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Fax | 940-521-9442
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Authorized Official
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Title or Position | OWNER
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Name | REBBEKAH DAVIS
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Credential |
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Telephone | 940-521-9460
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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 |
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License Number State |
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