Organization
EDDIE ETTE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. EDDIE ETTE (BUSINESS OWNER)
(817) 200-2363
Entity
Organization
Contact information
Practice address
705 E ABRAM ST, SUITE 100, ARLINGTON, TX 76010-1240
(817) 200-2363
(817) 200-2356
Mailing address
705 E ABRAM ST, SUITE 100, ARLINGTON, TX 76010-1240
(817) 200-2363
(817) 200-2356
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
332B00000X
TX
332BC3200X
Customized Equipment (DME)
0063143
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
158114201
MEDICAID CCP
TX
05
—
158114202
—
TX
01
—
17089399
EVERCARE
TX
01
—
531655
BLUE CROSS NUMBER
TX
Enumeration date
06/17/2006
Last updated
09/13/2011
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