Provider Demographics
NPI:1427093012
Name:EAGLE MEDICAL EQUIPMENT & SUPPLY CO.
Entity type:Organization
Organization Name:EAGLE MEDICAL EQUIPMENT & SUPPLY CO.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:UCHE
Authorized Official - Middle Name:E
Authorized Official - Last Name:NWABUNWANNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-342-6100
Mailing Address - Street 1:9304 FOREST LN
Mailing Address - Street 2:#238
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-6238
Mailing Address - Country:US
Mailing Address - Phone:214-342-6100
Mailing Address - Fax:214-342-6101
Practice Address - Street 1:9304 FOREST LN
Practice Address - Street 2:#238
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-6238
Practice Address - Country:US
Practice Address - Phone:214-342-6100
Practice Address - Fax:214-342-6101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-18
Last Update Date:2009-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0101641332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX6154070001Medicare NSC