Organization
MEDALL, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MIKE SCOTT WILBURN OP (PRESIDENT)
(817) 626-9991
Entity
Organization
Contact information
Practice address
221 W EXCHANGE AVE, SUITE 303, FORT WORTH, TX 76164-9614
(817) 626-9991
(817) 626-0920
Mailing address
PO BOX 185132, FORT WORTH, TX 76181-0132
(817) 626-9991
(817) 626-0920
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
5468630001
TX
332BX2000X
Oxygen Equipment & Supplies (DME)
5468630001
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
177887001
—
TX
05
—
177887002
—
TX
Enumeration date
07/10/2006
Last updated
08/08/2008
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