Provider Demographics
NPI:1962463075
Name:PATIENT SUPPORT SERVICES, INC
Entity type:Organization
Organization Name:PATIENT SUPPORT SERVICES, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATIONS OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCARTHY
Authorized Official - Suffix:
Authorized Official - Credentials:AO
Authorized Official - Phone:727-530-7700
Mailing Address - Street 1:19387 US HIGHWAY 19 N
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33764-3102
Mailing Address - Country:US
Mailing Address - Phone:800-284-2006
Mailing Address - Fax:
Practice Address - Street 1:3706 SUMMERHILL RD
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75503-3566
Practice Address - Country:US
Practice Address - Phone:903-838-4881
Practice Address - Fax:903-832-7264
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-29
Last Update Date:2021-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
TX0064969332BP3500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0946998-03Medicaid
SD4582207Medicaid
MO628689200Medicaid
OK100814340AMedicaid
AR145059716Medicaid
TX0946998-01Medicaid
TX0946998-02Medicaid
TX0946998-04Medicaid
AR115091733Medicaid
LA1437026Medicaid
TX0946998-01Medicaid
TX0946998-04Medicaid
AR115091733Medicaid
SCDM1057Medicaid
TX0946998-04Medicaid
AR115091733Medicaid
MS00440830Medicaid
TX0159485-01Medicaid