=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467517078
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SAMERICA MEDICAL SUPPLY COMPANY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/26/2006
-----------------------------------------------------
Last Update Date | 04/05/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3225 IH 30 SUITE H1
-----------------------------------------------------
City | MESQUITE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75150-2635
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-270-7226
-----------------------------------------------------
Fax | 972-692-2646
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3225 IH 30 SUITE H1
-----------------------------------------------------
City | MESQUITE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75150-2635
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-270-7226
-----------------------------------------------------
Fax | 972-692-2646
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATIVE MANAGER
-----------------------------------------------------
Name | MR. ADAM SALIA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 214-507-7803
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------