# MEDALL, INC.

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

## Provider details

- **NPI number:** 1649204694
- **Authorized official:** MIKE SCOTT WILBURN OP (PRESIDENT)
- **Authorized official phone:** (817) 626-9991

## Contact information

- **Practice address:** 221 W EXCHANGE AVE, SUITE 303, FORT WORTH, TX 76164-9614
- **Practice address phone:** (817) 626-9991
- **Practice address fax:** (817) 626-0920
- **Mailing address:** PO BOX 185132, FORT WORTH, TX 76181-0132
- **Mailing address phone:** (817) 626-9991
- **Mailing address fax:** (817) 626-0920

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | 5468630001 | TX | Yes |
| 332BX2000X | Oxygen Equipment & Supplies (DME) | 5468630001 | TX | — |

## Other

- **Enumeration date:** 07/10/2006
- **Last updated:** 08/08/2008