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General NPI Number Information
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NPI Number | 1669650115
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Entity Type | Organization
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Legal Business Name | SUE JOHNSON ALLEN
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Dates
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Enumeration Date | 02/07/2008
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Last Update Date | 06/30/2008
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Provider Practice Location Address
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Address Line | 303 COMMERCE ST
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City | BUFFALO
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State | TX
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Zip | 75831
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Country | US
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Telephone | 903-322-4326
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Fax | 903-322-5152
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Provider Business Mailing Address
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Address Line | PO BOX 188
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City | BUFFALO
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State | TX
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Zip | 75831-0188
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Country | US
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Telephone | 903-322-4326
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Fax | 903-322-5152
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Authorized Official
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Title or Position | OWNER
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Name | MS. SUE JOHNSON ALLEN
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Credential |
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Telephone | 903-322-4326
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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 | 0080876
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License Number State | TX
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