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General NPI Number Information
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NPI Number | 1760432538
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Entity Type | Organization
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Legal Business Name | AMBASSADOR MEDICAL SUPPLY OF TEXAS INC
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Dates
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Enumeration Date | 05/11/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1003 COLUMBIA STREET
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City | STAMFORD
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State | TX
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Zip | 79553
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Country | US
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Telephone | 325-773-3671
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Fax | 325-773-5751
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Provider Business Mailing Address
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Address Line | 1714 TEASLEY LANE
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City | DENTON
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State | TX
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Zip | 76205
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Country | US
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Telephone | 940-220-6440
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Fax | 940-220-6443
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Authorized Official
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Title or Position | PRESIDENT
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Name | JUSTIN FREEBOURN
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Credential |
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Telephone | 940-220-6440
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 120372
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License Number State | TX
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