Organization
PROVIDENT MEDICAL SUPPLY, INC
Active
Other names
Provident Medical Supply
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ROYCE FREEBOURN R.N. (OWNER)
(940) 220-6440
Entity
Organization
Contact information
Practice address
1714 TEASLEY LN, SUITE 101, DENTON, TX 76205-7795
(940) 383-5733
(940) 383-5700
Mailing address
1714 TEASLEY LN, SUITE 101, DENTON, TX 76205-7795
(940) 383-5733
(940) 383-5700
Taxonomy
Speciality
Code
Description
License number
State
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
Primary
C08406987
TX
Other
Enumeration date
05/24/2007
Last updated
08/22/2020
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