Organization
BROAD EXPRESS, INCORPORATED
Active
Other names
BROAD EXPRESS MEDICAL SUPPLY AND EQUIPMENT
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BABATUNDE JOSEPH ADEBIYI (PRESIDENT)
(972) 264-4448
Entity
Organization
Contact information
Practice address
2604 W MARSHALL DR, SUITE 104, GRAND PRAIRIE, TX 75051-3555
(972) 264-4448
(972) 642-7886
Mailing address
2604 W MARSHALL DR, SUITE 104, GRAND PRAIRIE, TX 75051-3555
(972) 264-4448
(972) 642-7886
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
0092486
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0000532440
BLUECROSS BLUESHIELD
TX
05
—
184098501
—
TX
05
—
184098502
—
TX
Enumeration date
02/13/2007
Last updated
02/04/2011
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