1730544982 NPI number — BEAN FAMILY ENTERPRISES

Table of content: (NPI 1730544982)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730544982 NPI number — BEAN FAMILY ENTERPRISES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BEAN FAMILY ENTERPRISES
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:
1730544982
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/12/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3449
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HARKER HEIGHTS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76548-0558
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
254-939-7171
Provider Business Mailing Address Fax Number:
254-939-2700

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7036 COYOTE RUN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRYAN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77808-5202
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
979-931-0677
Provider Business Practice Location Address Fax Number:
979-931-0677
Provider Enumeration Date:
12/15/2015

Additional Information

Authorized Official

Authorized Official Last Name:
BEAN
Authorized Official First Name:
LYNDA
Authorized Official Middle Name:
R
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
254-939-7171

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  1001255 , 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: 100255 . This is a "WHOLESALE DISTRIBUTOR OF COMPRESSED MEDICAL GAS DEVICE DISTRUBER" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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