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General NPI Number Information
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NPI Number | 1568804623
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Entity Type | Organization
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Legal Business Name | MIDCITIES MEDICAL SUPPLY DMEPOS
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Dates
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Enumeration Date | 07/17/2013
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Last Update Date | 07/17/2013
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Provider Practice Location Address
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Address Line | 215 N I 35 E
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City | DESOTO
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State | TX
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Zip | 75115-5225
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Country | US
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Telephone | 972-223-2882
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Fax | 972-223-2876
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Provider Business Mailing Address
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Address Line | 215 N I 35 E
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City | DESOTO
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State | TX
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Zip | 75115-5225
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Country | US
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Telephone | 972-223-2882
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Fax | 972-223-2876
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Authorized Official
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Title or Position | OWNER
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Name | ERIC ROBERTSON
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Credential | DMEPOS
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Telephone | 214-753-6721
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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 | TX
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