# PROVIDACARE MEDICAL SUPPLY, LTD.

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

## Provider details

- **NPI number:** 1316243728
- **Authorized official:** MR. RYAN N BENNETT (PARTNER)
- **Authorized official phone:** (512) 733-6518

## Contact information

- **Practice address:** 1514 S 31ST ST, TEMPLE, TX 76504-6752
- **Practice address phone:** (254) 778-2727
- **Practice address fax:** (254) 778-2729
- **Mailing address:** 3721 EXECUTIVE CENTER DRIVE, STE 102, AUSTIN, TX 78731-1615
- **Mailing address phone:** (512) 733-6518
- **Mailing address fax:** (512) 795-9185

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332BX2000X | Oxygen Equipment & Supplies (DME) | 1000495 | TX | Yes |

## Other

- **Enumeration date:** 02/02/2011
- **Last updated:** 02/02/2011