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Organization
STRACON
Active
Organization
STRACON
Active
Other names
Stracon Medical Supply
Organization subpart
No
Provider details
NPI number
Authorized official
MR. PHILIP A ADESULU (MANAGING OFFICER)
(972) 262-5053
Entity
Organization
Contact information
Practice address
810 DALWORTH ST STE B, GRAND PRAIRIE, TX 75050-5516
(972) 262-5053
(972) 262-7160
Mailing address
810 DALWORTH ST STE B, GRAND PRAIRIE, TX 75050-5516
(972) 262-5053
(972) 262-7160
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
0085290
TX
332B00000X
Durable Medical Equipment & Medical Supplies
—
NULL
Other
Enumeration date
10/31/2006
Last updated
10/01/2019
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