Provider Demographics
NPI:1023325610
Name:DELROSE MEDICAL EQUIPMENT & SUPPLY,INC
Entity type:Organization
Organization Name:DELROSE MEDICAL EQUIPMENT & SUPPLY,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:IGNA
Authorized Official - Middle Name:IKE
Authorized Official - Last Name:UGOH
Authorized Official - Suffix:
Authorized Official - Credentials:RRT,RCP
Authorized Official - Phone:972-699-9200
Mailing Address - Street 1:811 S CENTRAL EXPY
Mailing Address - Street 2:SUITE 541
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-7415
Mailing Address - Country:US
Mailing Address - Phone:972-699-9200
Mailing Address - Fax:972-699-9207
Practice Address - Street 1:811 S CENTRAL EXPY
Practice Address - Street 2:SUITE 541
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-7415
Practice Address - Country:US
Practice Address - Phone:972-699-9200
Practice Address - Fax:972-699-9207
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX332BX2000X
TX217057301332BC3200X
TX217057302332BX2000X
TX217057303332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX217057302Medicaid
TX217057301Medicaid
TX217057303Medicaid
TX6431920001Medicare NSC