1619231412 NPI number — MEDICAL PLUS SUPPLIES INC

Table of content: (NPI 1619231412)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619231412 NPI number — MEDICAL PLUS SUPPLIES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MEDICAL PLUS 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:
1619231412
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/23/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 84110
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PEARLAND
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77584-0018
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-440-6700
Provider Business Mailing Address Fax Number:
866-867-7395

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
109 RHODES ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CONROE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77301-4425
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-298-3948
Provider Business Practice Location Address Fax Number:
866-867-7395
Provider Enumeration Date:
06/27/2012

Additional Information

Authorized Official

Authorized Official Last Name:
RODRIGUEZ
Authorized Official First Name:
ESTEBAN
Authorized Official Middle Name:
V.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
713-440-6700

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  1000713 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332B00000X , with the licence number: 0033221 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 218050702 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 16097001 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1619231412 . This is a "NPI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 337174202 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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