=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922240654
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | UPTOWN MEDICAL SUPPLY & EQUIPMENT, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/26/2009
-----------------------------------------------------
Last Update Date | 03/26/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3129 INTERSTATE 30 SUITE A
-----------------------------------------------------
City | MESQUITE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75150-2701
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-534-1945
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3129 INTERSTATE 30 SUITE A
-----------------------------------------------------
City | MESQUITE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75150-2701
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-534-1945
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MS. PATRICIA A JONES
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 214-534-1945
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332BX2000X
-----------------------------------------------------
Taxonomy Name | Oxygen Equipment & Supplies (DME)
-----------------------------------------------------
License Number | 0089506
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------