Provider Demographics
NPI:1538394309
Name:ICON MEDICAL SUPPLIES
Entity type:Organization
Organization Name:ICON MEDICAL SUPPLIES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL
Authorized Official - Prefix:MR
Authorized Official - First Name:GREG
Authorized Official - Middle Name:
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-587-3760
Mailing Address - Street 1:2300 MCDERMOTT RD STE 200-199
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75025-7016
Mailing Address - Country:US
Mailing Address - Phone:214-383-9105
Mailing Address - Fax:214-383-9110
Practice Address - Street 1:2300 MCDERMOTT RD STE 200-199
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75025-7016
Practice Address - Country:US
Practice Address - Phone:214-383-9105
Practice Address - Fax:214-383-9110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-22
Last Update Date:2009-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies