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General NPI Number Information
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NPI Number | 1609029800
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Entity Type | Organization
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Legal Business Name | ERNIES HOUSE
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Dates
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Enumeration Date | 10/31/2008
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Last Update Date | 10/31/2008
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Provider Practice Location Address
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Address Line | 4321 MARTHA LN
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City | FORT WORTH
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State | TX
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Zip | 76103-2705
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Country | US
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Telephone | 817-386-3923
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Fax | 817-386-3923
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Provider Business Mailing Address
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Address Line | 4321 MARTHA LN
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City | FORT WORTH
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State | TX
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Zip | 76103-2705
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Country | US
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Telephone | 817-386-3923
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Fax | 817-386-3923
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Authorized Official
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Title or Position | OWNER OPERATOR
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Name | MR. ERNEST PERCY MIMS JR.
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Credential | DME
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Telephone | 817-386-3923
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number |
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License Number State |
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