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General NPI Number Information
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NPI Number | 1447522289
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Entity Type | Organization
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Legal Business Name | RICKY LEE COLEMAN
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Dates
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Enumeration Date | 02/08/2012
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Last Update Date | 02/08/2012
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Provider Practice Location Address
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Address Line | 3148 COUNTY ROAD 480
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City | KIRBYVILLE
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State | TX
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Zip | 75956-4328
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Country | US
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Telephone | 409-622-2635
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1092
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City | KIRBYVILLE
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State | TX
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Zip | 75956-1092
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Country | US
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Telephone | 409-622-2635
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | ALESHA GUNTER
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Credential |
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Telephone | 409-622-2884
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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 |
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License Number State |
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