Provider Demographics
NPI:1871317057
Name:SMG SUPPLIES LLC
Entity type:Organization
Organization Name:SMG SUPPLIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:WISLER
Authorized Official - Middle Name:
Authorized Official - Last Name:ISME
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-377-9760
Mailing Address - Street 1:9304 FOREST LN STE S212
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-6238
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9304 FOREST LN # S212
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-6238
Practice Address - Country:US
Practice Address - Phone:214-377-9760
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-13
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies