1144216896 NPI number — CADET MEDICAL SUPPLY LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144216896 NPI number — CADET MEDICAL SUPPLY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CADET MEDICAL SUPPLY LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1144216896
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 712
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BEDFORD
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76095-0712
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
817-656-2690
Provider Business Mailing Address Fax Number:
888-233-4861

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
700 W HARWOOD RD
Provider Second Line Business Practice Location Address:
SUITE E2
Provider Business Practice Location Address City Name:
HURST
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76054-3358
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-656-2690
Provider Business Practice Location Address Fax Number:
888-233-4816
Provider Enumeration Date:
09/27/2005

Additional Information

Authorized Official

Authorized Official Last Name:
YANCY
Authorized Official First Name:
DANIEL
Authorized Official Middle Name:
MCKINLEY
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
817-726-3910

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  0077082 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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