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General NPI Number Information
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NPI Number | 1740657105
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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 | 09/01/2015
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Last Update Date | 10/15/2021
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Provider Practice Location Address
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Address Line | 801 E WALKER ST
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City | BRECKENRIDGE
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State | TX
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Zip | 76424-3745
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Country | US
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Telephone | 254-559-2345
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Fax |
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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 |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | REBBEKAH 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 | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 1001185
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License Number State | TX
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