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General NPI Number Information
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NPI Number | 1417265208
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Entity Type | Organization
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Legal Business Name | ROY BOLTON
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Dates
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Enumeration Date | 09/15/2010
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Last Update Date | 03/23/2011
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Provider Practice Location Address
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Address Line | 704 W MAIN ST
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City | PALESTINE
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State | TX
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Zip | 75801-2608
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Country | US
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Telephone | 903-723-2355
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Fax | 903-723-1580
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Provider Business Mailing Address
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Address Line | PO BOX 841
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City | ELKHART
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State | TX
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Zip | 75839-0841
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Country | US
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Telephone | 903-723-2355
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Fax | 903-723-1580
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Authorized Official
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Title or Position | OWNER
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Name | MR. ROY HENRY BOLTON
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Credential | RN
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Telephone | 903-723-2355
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number | 0085013
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 332BN1400X
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Taxonomy Name | Nursing Facility Supplies (DME)
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License Number | 0085013
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 332BP3500X
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Taxonomy Name | Parenteral & Enteral Nutrition Supplies (DME)
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License Number | 0085013
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License Number State | TX
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Taxonomy #4
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Taxonomy Code | 332BX2000X
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Taxonomy Name | Oxygen Equipment & Supplies (DME)
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License Number | 0085013
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License Number State | TX
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Taxonomy #5
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 0085013
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License Number State | TX
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