Provider Demographics
NPI:1447986583
Name:MAVIDALA SUPPLY LLC
Entity type:Organization
Organization Name:MAVIDALA SUPPLY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:AZRA
Authorized Official - Middle Name:
Authorized Official - Last Name:MAJEED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:830-476-2811
Mailing Address - Street 1:701 TILLERY ST STE 12
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78702-3751
Mailing Address - Country:US
Mailing Address - Phone:830-476-2811
Mailing Address - Fax:
Practice Address - Street 1:701 TILLERY ST STE 12
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78702-3751
Practice Address - Country:US
Practice Address - Phone:830-476-2811
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-30
Last Update Date:2023-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies