Provider Demographics
NPI:1396703302
Name:PALM TREE MEDICAL PRODUCTS
Entity type:Organization
Organization Name:PALM TREE MEDICAL PRODUCTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TRICIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:DIAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-722-3800
Mailing Address - Street 1:103 N GOLIAD ST
Mailing Address - Street 2:SUITE 107
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75087-2572
Mailing Address - Country:US
Mailing Address - Phone:972-722-3800
Mailing Address - Fax:972-722-3814
Practice Address - Street 1:103 N GOLIAD ST
Practice Address - Street 2:SUITE 107
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75087-2572
Practice Address - Country:US
Practice Address - Phone:972-722-3800
Practice Address - Fax:972-722-3814
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX5232990001Medicare ID - Type Unspecified