Organization
MEDHAB
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOHNNY ROSS JR. (CHIEF EXECUTIVE OFFICER)
(817) 233-5271
Entity
Organization
Contact information
Practice address
2009 W BEAUREGARD AVE, SAN ANGELO, TX 76901-3812
(817) 233-5271
Mailing address
1120 SOUTH FWY, SUITE 105, FORT WORTH, TX 76104-5064
(817) 233-5271
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
332BC3200X
Customized Equipment (DME)
Primary
—
—
332BN1400X
Nursing Facility Supplies (DME)
—
—
335E00000X
Prosthetic/Orthotic Supplier
—
—
Other
Enumeration date
08/29/2011
Last updated
02/07/2013
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