Basic Information
| Provider Information | |||||||||
| NPI: | 1679175582 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HAYS MEDICAL SUPPLY LLC JUDSON STURDIVANT SOLE MBR | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5508 PARKCREST DR STE 200 | ||||||||
| Address2: | |||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787314929 | ||||||||
| CountryCode: | US | ||||||||
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| Address1: | 5508 PARKCREST DR STE 200 | ||||||||
| Address2: | |||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787314929 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5126979896 | ||||||||
| FaxNumber: | 5126979896 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/15/2020 | ||||||||
| LastUpdateDate: | 11/15/2020 | ||||||||
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| AuthorizedOfficialLastName: | STURDIVANT | ||||||||
| AuthorizedOfficialFirstName: | JUDSON | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 5126979896 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | HAYS MEDICAL SUPPLY LLC JUDSON STURDIVANT SOLE MBR | ||||||||
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| NPICertificationDate: | 11/15/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QS1200X | Y | Ambulatory Health Care Facilities | Clinic/Center | Sleep Disorder Diagnostic |
No ID Information.