1669570172 NPI number — COMFORT & CARE MEDICAL SUPPLIES, INC

Table of content: (NPI 1669570172)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669570172 NPI number — COMFORT & CARE MEDICAL SUPPLIES, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMFORT & CARE MEDICAL SUPPLIES, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1669570172
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/28/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
515 1ST ST E.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HUMBLE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77338-4604
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-450-4155
Provider Business Mailing Address Fax Number:
713-450-4177

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
515 1ST ST E.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HUMBLE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77338-4604
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-450-4155
Provider Business Practice Location Address Fax Number:
713-450-4177
Provider Enumeration Date:
09/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BEAN
Authorized Official First Name:
JERRETT
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO/OWNER
Authorized Official Telephone Number:
713-419-7400

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  0033422 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332BP3500X , with the licence number: 0033422 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BX2000X , with the licence number: 0033422 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 010543901 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 016325501 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0105439-01 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 519660 . This is a "BCBS OF TEXAS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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