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General NPI Number Information
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NPI Number | 1740205657
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Entity Type | Organization
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Legal Business Name | MINERAL WELLS MEDICAL SUPPLY, INC
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Dates
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Enumeration Date | 07/12/2006
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Last Update Date | 10/15/2021
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Provider Practice Location Address
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Address Line | 211 SW 25TH AVE
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City | MINERAL WELLS
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State | TX
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Zip | 76067-8241
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Country | US
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Telephone | 940-325-2706
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Fax | 940-325-4130
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Provider Business Mailing Address
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Address Line | PO BOX 1152
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City | MINERAL WELLS
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State | TX
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Zip | 76068-1152
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Country | US
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Telephone | 940-325-2706
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Fax | 940-325-4130
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | MRS. REBBEKAH NADINE DAVIS
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Credential |
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Telephone | 940-325-2706
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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 | 0035334
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License Number State | TX
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