Provider Demographics
NPI:1427288448
Name:CIPAN MEDICAL SUPPLY
Entity type:Organization
Organization Name:CIPAN MEDICAL SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHINYELU
Authorized Official - Middle Name:
Authorized Official - Last Name:NNAKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-699-8400
Mailing Address - Street 1:818 S CENTRAL EXPY
Mailing Address - Street 2:STE 4
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-7306
Mailing Address - Country:US
Mailing Address - Phone:972-699-8400
Mailing Address - Fax:972-699-8408
Practice Address - Street 1:818 S CENTRAL EXPY
Practice Address - Street 2:STE 4
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-7306
Practice Address - Country:US
Practice Address - Phone:972-699-8400
Practice Address - Fax:972-699-8408
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-24
Last Update Date:2010-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1000123332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX6384800001Medicare NSC