Provider Demographics
NPI:1871276725
Name:PIVOTAL MED SUPPLY LLC
Entity type:Organization
Organization Name:PIVOTAL MED SUPPLY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NOAH
Authorized Official - Middle Name:
Authorized Official - Last Name:SEITEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:866-510-0050
Mailing Address - Street 1:2010 E CONTINENTAL BLVD STE F
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-9734
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2010 E CONTINENTAL BLVD STE F
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-9734
Practice Address - Country:US
Practice Address - Phone:888-838-1558
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-08
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies