1154497188 NPI number — FISHER COUNTY DURA-MEDICAL EQUIPMENT CO.

Table of content: (NPI 1164133070)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154497188 NPI number — FISHER COUNTY DURA-MEDICAL EQUIPMENT CO.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FISHER COUNTY DURA-MEDICAL EQUIPMENT CO.
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:
6
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:
1154497188
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:
774 STATE HIGHWAY 70 N
Provider Second Line Business Mailing Address:
P.O. DRAWER F
Provider Business Mailing Address City Name:
ROTAN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79546-6918
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
325-735-2256
Provider Business Mailing Address Fax Number:
325-735-3070

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
774 STATE HIGHWAY 70 N
Provider Second Line Business Practice Location Address:
P.O. DRAWER F
Provider Business Practice Location Address City Name:
ROTAN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79546-6918
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
325-735-2256
Provider Business Practice Location Address Fax Number:
325-735-3070
Provider Enumeration Date:
11/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HELMS
Authorized Official First Name:
ELLA
Authorized Official Middle Name:
RAYE
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
325-735-2256

Provider Taxonomy Codes

  • Taxonomy code: 332BX2000X , with the licence number:  0072523 , 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)

  • Identifier: 530947 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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