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Organization
PROVIDACARE MEDICAL SUPPLY, LTD.
Active
Organization
PROVIDACARE MEDICAL SUPPLY, LTD.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RYAN N BENNETT (PARTNER)
(512) 733-6518
Entity
Organization
Contact information
Practice address
1514 S 31ST ST, TEMPLE, TX 76504-6752
(254) 778-2727
(254) 778-2729
Mailing address
3721 EXECUTIVE CENTER DRIVE, STE 102, AUSTIN, TX 78731-1615
(512) 733-6518
(512) 795-9185
Taxonomy
Speciality
Code
Description
License number
State
332BX2000X
Oxygen Equipment & Supplies (DME)
Primary
1000495
TX
Other
Enumeration date
02/02/2011
Last updated
02/02/2011
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