Organization
DESTINY MEDICAL SUPPLIES INC.,
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CHRISTOPHER PAUL BASSEY (CEO)
(817) 534-2770
Entity
Organization
Contact information
Practice address
4735 E LANCASTER AVE, FORT WORTH, TX 76103-3835
(817) 534-2770
(817) 534-2977
Mailing address
PO BOX 51088, FORT WORTH, TX 76105-8088
(817) 534-2770
(817) 534-2977
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
0055999
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
102881
AMERIGROUP ID#
TX
Enumeration date
06/21/2005
Last updated
08/22/2020
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