Provider Demographics
NPI:1194906446
Name:MEDICINE PLACE INC 1008 LAMAR ST SWEETWATER TX
Entity type:Organization
Organization Name:MEDICINE PLACE INC 1008 LAMAR ST SWEETWATER TX
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DME MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:WEEMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:325-235-4366
Mailing Address - Street 1:1410 LAMAR ST
Mailing Address - Street 2:
Mailing Address - City:SWEETWATER
Mailing Address - State:TX
Mailing Address - Zip Code:79556-7124
Mailing Address - Country:US
Mailing Address - Phone:325-235-4366
Mailing Address - Fax:325-236-6800
Practice Address - Street 1:1410 LAMAR ST
Practice Address - Street 2:
Practice Address - City:SWEETWATER
Practice Address - State:TX
Practice Address - Zip Code:79556-7124
Practice Address - Country:US
Practice Address - Phone:325-235-4366
Practice Address - Fax:325-236-6800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX332BP3500X, 332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX188749901Medicaid
TX1248300002Medicare NSC