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General NPI Number Information
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NPI Number | 1770646150
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Entity Type | Organization
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Legal Business Name | PROMED MEDICAL & RESPIRATORY SUPPLY, INC.
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Dates
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Enumeration Date | 12/18/2006
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Last Update Date | 01/20/2009
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Provider Practice Location Address
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Address Line | 1465 N MAIN ST
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City | VIDOR
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State | TX
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Zip | 77662-3009
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Country | US
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Telephone | 409-768-1500
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Fax | 409-768-1551
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Provider Business Mailing Address
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Address Line | 1465 N MAIN ST
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City | VIDOR
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State | TX
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Zip | 77662-3009
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Country | US
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Telephone | 409-768-1500
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Fax | 409-768-1551
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Authorized Official
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Title or Position | SECRETARY
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Name | MRS. REENE E. CHESSER
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Credential |
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Telephone | 409-768-1500
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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 | 010823501
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 332BX2000X
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Taxonomy Name | Oxygen Equipment & Supplies (DME)
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License Number | 016685201
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License Number State | TX
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