# PROVIDACARE MEDICAL SUPPLY LTD

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

## Provider details

- **NPI number:** 1700072824
- **Authorized official:** MR. RYAN N BENNETT (CEO)
- **Authorized official phone:** (512) 733-6518

## Contact information

- **Practice address:** 3724 EXECUTIVE CENTER DR, SUITE 250, AUSTIN, TX 78731-1646
- **Practice address phone:** (512) 326-9898
- **Practice address fax:** (512) 326-9190
- **Mailing address:** PO BOX 27010, AUSTIN, TX 78755-2010
- **Mailing address phone:** (512) 733-6518

## Taxonomy

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

## Other

- **Enumeration date:** 09/21/2007
- **Last updated:** 07/17/2012