MEDICARE: THE BILLIONAIRE WOMEN'S CLUB CHARITY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies
2	332BC3200X	Customized Equipment (DME)

General Provider Information

NPI Number	:	1811616196
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE BILLIONAIRE WOMEN'S CLUB CHARITY

Provider Business Mailing Address
First Line	:	1910 PACIFIC AVE # 12015
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75201-4529
Country	:	US
Telephone Number	:	972-803-5940
Fax Number	:

Provider Business Practice Location Address
First Line	:	1910 PACIFIC AVE # 12015
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75201-4529
Country	:	US
Telephone Number	:	972-803-5940
Fax Number	:	214-484-1972

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MS. QUANTAE THOMAS
Credential	:	DEVICE DISTRIBUTOR
Telephone Number	:	214-727-5791

Provider Enumeration Date	:	08/22/2022
Last Update Date	:	07/08/2024

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