Organization
MINERAL WELLS MEDICAL SUPPLY, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. REBBEKAH NADINE DAVIS (PRESIDENT/OWNER)
(940) 325-2706
Entity
Organization
Contact information
Practice address
211 SW 25TH AVE, MINERAL WELLS, TX 76067-8241
(940) 325-2706
(940) 325-4130
Mailing address
PO BOX 1152, MINERAL WELLS, TX 76068-1152
(940) 325-2706
(940) 325-4130
Taxonomy
Speciality
Code
Description
License number
State
332BX2000X
Oxygen Equipment & Supplies (DME)
Primary
0035334
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
015895801
—
TX
05
—
087075001
—
TX
01
—
44995
AETNA MEDICAID
TX
01
—
513486
BLUE CROSS BLUE SHIELD
TX
Enumeration date
07/12/2006
Last updated
10/15/2021
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