Provider Demographics
NPI:1124245105
Name:STAFFORD MEDICAL SUPPLY INC
Entity type:Organization
Organization Name:STAFFORD MEDICAL SUPPLY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:IWOBI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-277-0452
Mailing Address - Street 1:4645 HIGHWAY 90A
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:TX
Mailing Address - Zip Code:77477-4726
Mailing Address - Country:US
Mailing Address - Phone:281-277-0452
Mailing Address - Fax:281-277-0453
Practice Address - Street 1:4645 HIGHWAY 90A
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:TX
Practice Address - Zip Code:77477-4726
Practice Address - Country:US
Practice Address - Phone:281-277-0452
Practice Address - Fax:281-277-0453
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332BN1400XSuppliersDurable Medical Equipment & Medical SuppliesNursing Facility Supplies
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX5968270001Medicare NSC