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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 (CEO)
(512) 733-6518
Entity
Organization
Contact information
Practice address
8303 N MOPAC EXPY STE A215, AUSTIN, TX 78759-8751
(512) 733-6500
(512) 733-6511
Mailing address
PO BOX 27010, AUSTIN, TX 78755-2010
(512) 733-6500
(512) 733-6511
Taxonomy
Speciality
Code
Description
License number
State
332BX2000X
Oxygen Equipment & Supplies (DME)
Primary
0089310
TX
Other
Enumeration date
06/16/2006
Last updated
05/19/2023
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