Basic Information
| Provider Information | |||||||||
| NPI: | 1811071236 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ACTION02 MEDICAL SUPPLIES,LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 106 N GRACE ST | ||||||||
| Address2: | |||||||||
| City: | CROCKETT | ||||||||
| State: | TX | ||||||||
| PostalCode: | 758351722 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9365447202 | ||||||||
| FaxNumber: | 9365462029 | ||||||||
| Practice Location | |||||||||
| Address1: | 106 N GRACE ST | ||||||||
| Address2: | |||||||||
| City: | CROCKETT | ||||||||
| State: | TX | ||||||||
| PostalCode: | 758351722 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9365447202 | ||||||||
| FaxNumber: | 9365462029 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/24/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | HORNE | ||||||||
| AuthorizedOfficialFirstName: | CYNTHIA | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 9365447202 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | RN, BSN | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X | Y | Suppliers | Durable Medical Equipment & Medical Supplies |
No ID Information.