| NPI | 1336350107 |
|---|---|
| Other Name | PROVIDENT MEDICAL SUPPLY |
| Entity Type | Organization |
| Authorized Contact | ROYCE FREEBOURN Owner 940-220-6440 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332BP3500X Durable Medical Equipment & Medical Supplies, Parenteral & Enteral Nutrition (Licence: TX C08406987) |
| Enumeration Date | 2007-05-24 |
| Last Update Date | 2020-08-22 |