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General NPI Number Information
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NPI Number | 1497097612
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Entity Type | Organization
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Legal Business Name | BRAZOS MEDICAL SUPPLY, LLC
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Dates
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Enumeration Date | 03/26/2013
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Last Update Date | 03/26/2013
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Provider Practice Location Address
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Address Line | 2005 OLD GREENBRIER RD SUITE #106
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City | CHESAPEAKE
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State | VA
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Zip | 23320-2649
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Country | US
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Telephone | 757-675-6400
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Fax |
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Provider Business Mailing Address
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Address Line | 2005 OLD GREENBRIER RD SUITE #106
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City | CHESAPEAKE
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State | VA
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Zip | 23320-2649
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Country | US
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Telephone | 757-675-6400
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Fax |
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Authorized Official
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Title or Position | VICE PRESIDENT/COO
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Name | MR. KEVIN RAY CRUM
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Credential |
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Telephone | 757-675-6400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BX2000X
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Taxonomy Name | Oxygen Equipment & Supplies (DME)
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License Number | S4451904
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License Number State | VA
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