Providacare Medical Supply LTD

Primary specialty

Oxygen Equipment & Supplies (DME)Taxonomy code 332BX2000X

License

0089310 Issued in TX

Legal business name

PROVIDACARE MEDICAL SUPPLY LTD

Practice address

8303 N Mopac Expy Ste A215
Austin, TX 78759-8751

Phone

(512) 733-6500

Fax

(512) 733-6511

NPI assigned

Jun 16, 2006

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

Ceo

Phone

(512) 733-6518

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

Tax ID family

Providacare Medical Supply LTD2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Providacare Medical Supply LTD

  • Durable Medical Equipment & Medical Supplies
  • Duluth, MN
  • NPI 1386895746
  NPD tax ID

Locations

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

{
    "created_epoch": "1150416000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1684454400000",
    "number": "1457395568",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 27010",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787552010",
            "telephone_number": "512-733-6500",
            "fax_number": "512-733-6511"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8303 N MOPAC EXPY STE A215",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787598751",
            "telephone_number": "512-733-6500",
            "fax_number": "512-733-6511"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDACARE MEDICAL SUPPLY LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-16",
        "last_updated": "2023-05-19",
        "certification_date": "2023-05-19",
        "status": "A",
        "authorized_official_last_name": "BENNETT",
        "authorized_official_first_name": "RYAN",
        "authorized_official_middle_name": "N",
        "authorized_official_title_or_position": "CEO",
        "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": "0089310",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "180009601",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Providing Justice LLC

• Oxygen Equipment & Supplies (DME) in Austin, TX
• Providers in Austin, 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 May 19, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.