Organization
ROOSTER MEDICAL EQUIPMENT & SUPPLIES
Active
Organization
ROOSTER MEDICAL EQUIPMENT & SUPPLIES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
B J EKANEM (OWNER)
(817) 923-1900
Entity
Organization
Contact information
Practice address
3000 SANDAGE AVE, 109, FORT WORTH, TX 76109-1768
(817) 923-1900
(817) 923-1952
Mailing address
3000 SANDAGE AVE, 109, FORT WORTH, TX 76109-1768
(817) 923-1900
(817) 923-1952
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
0060761
TX
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
Primary
0060761
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1513520102
—
TX
01
—
531195
BLUE CROSS/BLUE SHIELD
TX
Enumeration date
08/22/2005
Last updated
09/11/2025
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