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General NPI Number Information
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NPI Number | 1649204694
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Entity Type | Organization
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Legal Business Name | MEDALL, INC.
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Dates
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Enumeration Date | 07/10/2006
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Last Update Date | 08/08/2008
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Provider Practice Location Address
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Address Line | 221 W EXCHANGE AVE SUITE 303
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City | FORT WORTH
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State | TX
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Zip | 76164-9614
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Country | US
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Telephone | 817-626-9991
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Fax | 817-626-0920
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Provider Business Mailing Address
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Address Line | PO BOX 185132
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City | FORT WORTH
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State | TX
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Zip | 76181-0132
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Country | US
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Telephone | 817-626-9991
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Fax | 817-626-0920
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Authorized Official
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Title or Position | PRESIDENT
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Name | MIKE SCOTT WILBURN
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Credential | OP
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Telephone | 817-626-9991
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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 | 5468630001
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 5468630001
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License Number State | TX
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