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
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