Stracon

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

License

0085290 Issued in TX

Legal business name

STRACON

Practice address

810 Dalworth St Ste B
Grand Prairie, TX 75050-5516

Phone

(972) 262-5053

Fax

(972) 262-7160

NPI assigned

Oct 31, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Philip A Adesulu

Title

Managing Officer

Phone

(972) 262-5053

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• Stracon Medical Supply Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1162252800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1569888000000",
    "number": "1053497008",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "810 DALWORTH ST STE B",
            "city": "GRAND PRAIRIE",
            "state": "TX",
            "postal_code": "750505516",
            "telephone_number": "972-262-5053",
            "fax_number": "972-262-7160"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "810 DALWORTH ST STE B",
            "city": "GRAND PRAIRIE",
            "state": "TX",
            "postal_code": "750505516",
            "telephone_number": "972-262-5053",
            "fax_number": "972-262-7160"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "812 Dalworth St",
            "address_purpose": "LOCATION",
            "city": "Grand Prairie",
            "state": "TX",
            "postal_code": "750505545",
            "country_code": "US",
            "telephone_number": "972-262-5053",
            "fax_number": "972-262-7160",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "STRACON",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-31",
        "last_updated": "2019-10-01",
        "status": "A",
        "authorized_official_last_name": "ADESULU",
        "authorized_official_first_name": "PHILIP",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "MANAGING OFFICER",
        "authorized_official_telephone_number": "972-262-5053",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "TX",
            "license": "0085290",
            "primary": true
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "179685602",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "179685601",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Stracon Medical Supply",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Stracon Medical Supply",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Durable Medical Equipment & Medical Supplies in Grand Prairie, TX
• Providers in Grand Prairie, TX by specialty
• Durable Medical Equipment & Medical Supplies in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.