Provider Demographics
NPI:1427142272
Name:ABUNDANT LIFE MEDICAL EQUIPMENT & SUPPLY LIMITED
Entity type:Organization
Organization Name:ABUNDANT LIFE MEDICAL EQUIPMENT & SUPPLY LIMITED
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:SHAJI
Authorized Official - Middle Name:K
Authorized Official - Last Name:DANIEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-681-5959
Mailing Address - Street 1:949 W KEARNEY ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75149-8805
Mailing Address - Country:US
Mailing Address - Phone:972-681-5959
Mailing Address - Fax:
Practice Address - Street 1:949 W KEARNEY ST
Practice Address - Street 2:SUITE 102
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75149-8805
Practice Address - Country:US
Practice Address - Phone:972-681-5959
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0087565332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX181708202Medicaid
TX181708201Medicaid
TX5684880001Medicare ID - Type Unspecified