Provider Demographics
NPI:1346074770
Name:PELLA MEDICAL SUPPLY INC
Entity type:Organization
Organization Name:PELLA MEDICAL SUPPLY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:EHIMWENMA
Authorized Official - Middle Name:KEVIN
Authorized Official - Last Name:OWEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-410-1889
Mailing Address - Street 1:9304 FOREST LN STE 256
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-6245
Mailing Address - Country:US
Mailing Address - Phone:214-954-7033
Mailing Address - Fax:214-954-7030
Practice Address - Street 1:9304 FOREST LN STE 256
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-6245
Practice Address - Country:US
Practice Address - Phone:214-954-7033
Practice Address - Fax:214-954-7030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-28
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies