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General NPI Number Information
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NPI Number | 1841487774
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Entity Type | Organization
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Legal Business Name | S.M.A. MEDICAL SUPPLY LLC
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Dates
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Enumeration Date | 09/25/2007
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Last Update Date | 09/25/2007
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Provider Practice Location Address
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Address Line | 613 COIT RD
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City | PLANO
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State | TX
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Zip | 75075-5704
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Country | US
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Telephone | 269-274-1414
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Fax | 972-407-9232
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Provider Business Mailing Address
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Address Line | 18012 CARROLLWOOD DR
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City | DALLAS
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State | TX
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Zip | 75252-6330
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Country | US
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Telephone | 269-274-1414
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Fax | 972-407-9232
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Authorized Official
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Title or Position | OWNER
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Name | DANA CRAVEN
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Credential |
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Telephone | 269-274-1414
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BP3500X
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Taxonomy Name | Parenteral & Enteral Nutrition Supplies (DME)
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License Number | 0099324
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 0099324
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License Number State | TX
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