Organization
PROVIDACARE MEDICAL SUPPLY LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RYAN N BENNETT (CEO)
(512) 733-6518
Entity
Organization
Contact information
Practice address
3724 EXECUTIVE CENTER DR, SUITE 250, AUSTIN, TX 78731-1646
(512) 326-9898
(512) 326-9190
Mailing address
PO BOX 27010, AUSTIN, TX 78755-2010
(512) 733-6518
Taxonomy
Speciality
Code
Description
License number
State
332BX2000X
Oxygen Equipment & Supplies (DME)
Primary
—
—
Other
Enumeration date
09/21/2007
Last updated
07/17/2012
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