Organization Name: | ELIZABETH D.EBOLUM |
NPI Number: | 1790860344 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | ELIZABETH D OPALEYE (DIR OF OPERATIONS) |
Mailing Address: | 1704 N Hampton Rd Ste 207 Desoto |
State: | TX US |
Postal Code: | 751158623 |
Phone Number: | 9722244500 |
Fax Number: | 9722244501 |
NPI Enumeration Date: | 10/25/2006 |
NPI Last Update Date: | 11/14/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 332B00000X |
License Number: | 166130802 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | TX |
Taxonomy Type: | Suppliers |
Taxonomy Classification: | Durable Medical Equipment & Medical Supplies |
Taxonomy Specialization: | |
Taxonomy Definition: | A supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient |