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General NPI Number Information
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NPI Number | 1396982401
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Entity Type | Organization
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Legal Business Name | IGIETSU MEDICAL GENERAL MERCHANDIZE/SUPPLIES
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Dates
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Enumeration Date | 01/12/2009
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Last Update Date | 09/23/2009
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Provider Practice Location Address
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Address Line | 1411 E ABRAM ST STE D
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City | ARLINGTON
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State | TX
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Zip | 76010-7228
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Country | US
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Telephone | 817-300-3640
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Fax | 817-277-4406
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Provider Business Mailing Address
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Address Line | 1411 EAST ABRAM ST.STE. D
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City | ARLINGTON
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State | TX
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Zip | 76010
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Country | US
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Telephone | 817-300-3640
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Fax | 817-277-4406
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Authorized Official
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Title or Position | OWNER
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Name | MR. AHMADU IGIETSU
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Credential |
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Telephone | 817-300-3640
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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 | 0093044
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License Number State | TX
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