Provider Demographics
NPI:1093998916
Name:OPEN-HEAVEN MEDICAL SUPPLY LLC
Entity type:Organization
Organization Name:OPEN-HEAVEN MEDICAL SUPPLY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:OLALEKAN
Authorized Official - Last Name:AMOSUN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-459-5555
Mailing Address - Street 1:860 HEBRON PKWY
Mailing Address - Street 2:SUITE 502
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75057-5003
Mailing Address - Country:US
Mailing Address - Phone:972-459-5555
Mailing Address - Fax:
Practice Address - Street 1:860 HEBRON PKWY
Practice Address - Street 2:SUITE 502
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75057-5003
Practice Address - Country:US
Practice Address - Phone:972-459-5555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-13
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
N/A332B00000X
TX6043840001332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX6043840001Medicare NSC