Provider Demographics
NPI:1427135235
Name:SUPPORT MEDICAL COMPANY
Entity type:Organization
Organization Name:SUPPORT MEDICAL COMPANY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CORP. SECRETARY
Authorized Official - Prefix:MR
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:
Authorized Official - Last Name:LOSKILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-792-9770
Mailing Address - Street 1:300 W AVENUE A # 4
Mailing Address - Street 2:
Mailing Address - City:SEMINOLE
Mailing Address - State:TX
Mailing Address - Zip Code:79360-3550
Mailing Address - Country:US
Mailing Address - Phone:432-758-6507
Mailing Address - Fax:432-758-6626
Practice Address - Street 1:300 W AVENUE A # 4
Practice Address - Street 2:
Practice Address - City:SEMINOLE
Practice Address - State:TX
Practice Address - Zip Code:79360-3550
Practice Address - Country:US
Practice Address - Phone:432-758-6507
Practice Address - Fax:432-758-6626
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUPPORT MEDICAL COMPANY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-01
Last Update Date:2011-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NOT APPLICABLE332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1711251-01Medicaid
TX1711251-02Medicaid
TX0581190002Medicare ID - Type Unspecified