Provider Demographics
NPI:1801076518
Name:HAASTADE MEDICAL SUPPLY
Entity type:Organization
Organization Name:HAASTADE MEDICAL SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:ADESHOLA
Authorized Official - Middle Name:
Authorized Official - Last Name:OYENUGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-235-8383
Mailing Address - Street 1:811 S CENTRAL EXPY
Mailing Address - Street 2:SUITE 536
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-7415
Mailing Address - Country:US
Mailing Address - Phone:972-235-8383
Mailing Address - Fax:972-235-8384
Practice Address - Street 1:811 S CENTRAL EXPY
Practice Address - Street 2:SUITE 536
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-7415
Practice Address - Country:US
Practice Address - Phone:972-235-8383
Practice Address - Fax:972-235-8384
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-09
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0083557332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX177902701Medicaid
TX177902702Medicaid
TX5565420001Medicare NSC