Organization
CRESTVIEW MEDICAL EQUIPMENT SUPPLY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. OLUMUYIWA AKINYODE (PRESIDENT/CEO)
(972) 853-7422
Entity
Organization
Contact information
Practice address
2100 S GREAT SOUTHWEST PKWY, STE 103, GRAND PRAIRIE, TX 75051-3543
(972) 853-7422
Mailing address
2100 S GREAT SOUTHWEST PKWY, STE 103, GRAND PRAIRIE, TX 75051-3543
(972) 853-7422
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
211490201
—
TX
05
—
211490202
—
TX
Enumeration date
10/17/2008
Last updated
07/26/2016
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