Organization · NPI-2

Afaha M Asangansi

Durable Medical Equipment & Medical Supplies · Tyler, TX

NPI number1194726455
StatusActive
Last updated in NPPESAug 3, 2011

Details

NPI
1194726455
Entity type
Organization (NPI-2)
Legal business name
Afaha M Asangansi
Organization subpart
No
Enumeration date
Aug 9, 2005
Last updated
Aug 3, 2011

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
332B00000X Durable Medical Equipment & Medical Supplies161161801TXYes

Practice location

7524 S Broadway Ave
Ste120
Tyler, TX 75703-5007

Phone 903-509-3987 · Fax 903-509-9428

Mailing address

7524 S Broadway Ave
Suite 120
Tyler, TX 75703-5007

Phone 903-509-3987 · Fax 903-509-9428

Authorized official

Afaha Matthew Asangansi
Owner Operator
9035093987

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