Provider Demographics
NPI:1417014374
Name:ALLTEXAS MEDICAL SUPPLIES,LLC
Entity type:Organization
Organization Name:ALLTEXAS MEDICAL SUPPLIES,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.E.O
Authorized Official - Prefix:MS
Authorized Official - First Name:NKOYO
Authorized Official - Middle Name:S
Authorized Official - Last Name:EKPENYONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-660-7995
Mailing Address - Street 1:3727 DILIDO RD
Mailing Address - Street 2:SUITE 126
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75228-5531
Mailing Address - Country:US
Mailing Address - Phone:214-660-7995
Mailing Address - Fax:214-660-7331
Practice Address - Street 1:3727 DILIDO RD
Practice Address - Street 2:SUITE 126
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75228-5531
Practice Address - Country:US
Practice Address - Phone:214-660-7995
Practice Address - Fax:214-660-7331
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0093253332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX185131301Medicaid
TX185131302Medicaid
TX5822550001Medicare NSC