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General NPI Number Information
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NPI Number | 1295877645
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Entity Type | Organization
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Legal Business Name | BROAD EXPRESS, INCORPORATED
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Dates
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Enumeration Date | 02/13/2007
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Last Update Date | 02/04/2011
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Provider Practice Location Address
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Address Line | 2604 W MARSHALL DR SUITE 104
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City | GRAND PRAIRIE
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State | TX
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Zip | 75051-3555
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Country | US
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Telephone | 972-264-4448
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Fax | 972-642-7886
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Provider Business Mailing Address
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Address Line | 2604 W MARSHALL DR SUITE 104
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City | GRAND PRAIRIE
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State | TX
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Zip | 75051-3555
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Country | US
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Telephone | 972-264-4448
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Fax | 972-642-7886
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. BABATUNDE JOSEPH ADEBIYI
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Credential |
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Telephone | 972-264-4448
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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 | 0092486
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License Number State | TX
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