Tide Medical Supply

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

License

0089915 Issued in TX

Legal business name

TIDE MEDICAL SUPPLY

Practice address

2304 Oak LN
Suite 13
Grand Prairie, TX 75051-8812

Phone

(972) 264-3000

Fax

(972) 264-3000

NPI assigned

Jan 31, 2008

Organization subpart

No

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

Authorized official

Name

Mr. Thomas Adedayo Ogungbire

Title

Owner

Phone

(972) 264-3000

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1201737600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1201737600000",
    "number": "1821276973",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2304 OAK LN",
            "address_2": "SUITE 13",
            "city": "GRAND PRAIRIE",
            "state": "TX",
            "postal_code": "750518812",
            "telephone_number": "972-264-3000",
            "fax_number": "972-264-3000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2304 OAK LN",
            "address_2": "SUITE 13",
            "city": "GRAND PRAIRIE",
            "state": "TX",
            "postal_code": "750518812",
            "telephone_number": "972-264-3000",
            "fax_number": "972-264-3000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TIDE MEDICAL SUPPLY",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-01-31",
        "last_updated": "2008-01-31",
        "status": "A",
        "authorized_official_last_name": "OGUNGBIRE",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_middle_name": "ADEDAYO",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "972-264-3000",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "TX",
            "license": "0089915",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "187864701",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2008; 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.