Organization
AMERICAN EAGLE MEDICAL SUPPLY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JASON M HOLMES (OWNER)
(409) 769-3897
Entity
Organization
Contact information
Practice address
2612 N MAIN ST, VIDOR, TX 77662-2674
(409) 769-3897
(409) 783-9758
Mailing address
2612 N MAIN ST, VIDOR, TX 77662-2674
(409) 769-3897
(409) 783-9758
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
1000851
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1000851
TEXAS REGULATORY LICENSE
TX
Enumeration date
02/21/2012
Last updated
02/21/2012
Update your record
If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS at https://nppes.cms.hhs.gov.
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