Provider Demographics
NPI:1316255839
Name:SISSON MEDICAL PRODUCTS LLC
Entity type:Organization
Organization Name:SISSON MEDICAL PRODUCTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:SISSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-268-2020
Mailing Address - Street 1:1500 NORWOOD DR BLDG C
Mailing Address - Street 2:
Mailing Address - City:HURST
Mailing Address - State:TX
Mailing Address - Zip Code:76054-3651
Mailing Address - Country:US
Mailing Address - Phone:817-268-2020
Mailing Address - Fax:817-268-3737
Practice Address - Street 1:1500 NORWOOD DR BLDG C
Practice Address - Street 2:
Practice Address - City:HURST
Practice Address - State:TX
Practice Address - Zip Code:76054-3651
Practice Address - Country:US
Practice Address - Phone:817-268-2020
Practice Address - Fax:817-268-3737
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-17
Last Update Date:2010-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX32009234074332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies