# PROVIDACARE MEDICAL SUPPLY LTD

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1033360490
- **Authorized official:** MR. RYAN N BENNETT (CEO)
- **Authorized official phone:** (512) 733-6518

## Contact information

- **Practice address:** 1300 HWY 281, MARBLE FALLS, TX 78654-4504
- **Practice address phone:** (830) 693-7313
- **Practice address fax:** (830) 693-7363
- **Mailing address:** 3721 EXECUTIVE CENTER DR, SUITE 102, AUSTIN, TX 78731-1645
- **Mailing address phone:** (512) 733-6518
- **Mailing address fax:** (512) 795-9185

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | Yes |

## Other

- **Enumeration date:** 10/03/2008
- **Last updated:** 08/30/2010