Mineral Wells Medical Supply, Inc

Primary specialty

Oxygen Equipment & Supplies (DME)Taxonomy code 332BX2000X

License

0035334 Issued in TX

Legal business name

MINERAL WELLS MEDICAL SUPPLY, INC

Practice address

211 SW 25TH Ave
Mineral Wells, TX 76067-8241

Phone

(940) 325-2706

Fax

(940) 325-4130

NPI assigned

Jul 12, 2006

Organization subpart

No

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

Authorized official

Name

Mrs. Rebbekah Nadine Davis

Title

President/Owner

Phone

(940) 325-2706

Specialties & licenses 1

Addresses

Other identifiers 4

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

Mineral Wells Medical S2 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.

• Mineral Wells Medical Supply, Inc

  dba Breckenridge Medical Supply

  • Durable Medical Equipment & Medical Supplies
  • Breckenridge, TX
  • NPI 1740657105
  NPD tax ID

Locations

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

{
    "created_epoch": "1152662400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1634256000000",
    "number": "1740205657",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1152",
            "city": "MINERAL WELLS",
            "state": "TX",
            "postal_code": "760681152",
            "telephone_number": "940-325-2706",
            "fax_number": "940-325-4130"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "211 SW 25TH AVE",
            "city": "MINERAL WELLS",
            "state": "TX",
            "postal_code": "760678241",
            "telephone_number": "940-325-2706",
            "fax_number": "940-325-4130"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MINERAL WELLS MEDICAL SUPPLY, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-12",
        "last_updated": "2021-10-15",
        "certification_date": "2021-10-15",
        "status": "A",
        "authorized_official_last_name": "DAVIS",
        "authorized_official_first_name": "REBBEKAH",
        "authorized_official_middle_name": "NADINE",
        "authorized_official_title_or_position": "PRESIDENT/OWNER",
        "authorized_official_telephone_number": "940-325-2706",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "332BX2000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Oxygen Equipment & Supplies",
            "state": "TX",
            "license": "0035334",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "513486",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "087075001",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "015895801",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA MEDICAID",
            "identifier": "44995",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Med Pavilion PC
• Mary Kwaa Mens, RN, FNP-C
• Sarah Merritt, DC
• Mineral Wells Eye Center PLLC
• Mineral Wells Isd
• Mineral Wells Nursing and Rehabilitation LP
• Mineral Wells Women's Pavilion, P.a.
• Mineral Wells, PLLC
• Lillian Monroe, PHARMD
• Bryan Macritchie Morrison

• Oxygen Equipment & Supplies (DME) in Mineral Wells, TX
• Providers in Mineral Wells, 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 Oct 15, 2021; 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.