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General NPI Number Information
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NPI Number | 1831109941
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Entity Type | Organization
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Legal Business Name | TRICARE MEDICAL
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Dates
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Enumeration Date | 08/09/2006
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Last Update Date | 06/19/2012
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Provider Practice Location Address
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Address Line | 120 CLUBVIEW DR
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City | LEVELLAND
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State | TX
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Zip | 79336-6304
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Country | US
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Telephone | 806-894-0144
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Fax | 806-894-6777
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Provider Business Mailing Address
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Address Line | PO BOX 476
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City | LEVELLAND
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State | TX
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Zip | 79336-0476
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Country | US
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Telephone | 806-894-0144
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Fax | 806-894-6777
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Authorized Official
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Title or Position | OWNER GEN MGR
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Name | MR. RICK D LAWLESS
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Credential |
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Telephone | 806-894-0144
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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 |
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License Number State |
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