Providacare Medical Supply, LTD.

Primary specialty

Oxygen Equipment & Supplies (DME)Taxonomy code 332BX2000X

License

1000495 Issued in TX

Legal business name

PROVIDACARE MEDICAL SUPPLY, LTD.

Practice address

1514 S 31St St
Temple, TX 76504-6752

Phone

(254) 778-2727

Fax

(254) 778-2729

NPI assigned

Feb 2, 2011

Organization subpart

No

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

Authorized official

Name

Mr. Ryan N Bennett

Title

Partner

Phone

(512) 733-6518

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1296604800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1296604800000",
    "number": "1316243728",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3721 EXECUTIVE CENTER DRIVE",
            "address_2": "STE 102",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787311615",
            "telephone_number": "512-733-6518",
            "fax_number": "512-795-9185"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1514 S 31ST ST",
            "city": "TEMPLE",
            "state": "TX",
            "postal_code": "765046752",
            "telephone_number": "254-778-2727",
            "fax_number": "254-778-2729"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDACARE MEDICAL SUPPLY, LTD.",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-02-02",
        "last_updated": "2011-02-02",
        "status": "A",
        "authorized_official_last_name": "BENNETT",
        "authorized_official_first_name": "RYAN",
        "authorized_official_middle_name": "N",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "512-733-6518",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "332BX2000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Oxygen Equipment & Supplies",
            "state": "TX",
            "license": "1000495",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Oxygen Equipment & Supplies (DME) in Temple, TX
• Providers in Temple, TX by specialty
• Oxygen Equipment & Supplies (DME) in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 2, 2011; 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.