Provider Demographics
NPI:1447354139
Name:BAASELAR MEDICAL SUPPLIES
Entity type:Organization
Organization Name:BAASELAR MEDICAL SUPPLIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:EKENG
Authorized Official - Middle Name:ANSA
Authorized Official - Last Name:HENSHAW
Authorized Official - Suffix:
Authorized Official - Credentials:BSC
Authorized Official - Phone:469-855-7240
Mailing Address - Street 1:11438 GOODNIGHT LANE
Mailing Address - Street 2:SUITE D
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75229-2061
Mailing Address - Country:US
Mailing Address - Phone:972-241-1300
Mailing Address - Fax:972-241-1327
Practice Address - Street 1:11438 GOODNIGHT LANE
Practice Address - Street 2:STE D
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75229-2061
Practice Address - Country:US
Practice Address - Phone:972-241-1300
Practice Address - Fax:972-241-1327
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-12
Last Update Date:2008-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
4912600001Medicare NSC