Provider Demographics
NPI:1306171285
Name:PD MEDICAL SUPPLY INC
Entity type:Organization
Organization Name:PD MEDICAL SUPPLY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINSTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:AIGBOGUN
Authorized Official - Last Name:ERIMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-878-6315
Mailing Address - Street 1:9550 FOREST LN
Mailing Address - Street 2:SUITE 603
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-5905
Mailing Address - Country:US
Mailing Address - Phone:469-878-6315
Mailing Address - Fax:
Practice Address - Street 1:9550 FOREST LN
Practice Address - Street 2:SUITE 603
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243
Practice Address - Country:US
Practice Address - Phone:469-878-6315
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-09
Last Update Date:2009-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies