1982649844 NPI number — TEXAS DURABLE MEDICAL CO

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982649844 NPI number — TEXAS DURABLE MEDICAL CO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TEXAS DURABLE MEDICAL CO
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:
1982649844
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/21/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8449 W BELLFORT ST
Provider Second Line Business Mailing Address:
#110
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77071-2245
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-771-8362
Provider Business Mailing Address Fax Number:
713-771-8364

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8449 W BELLFORT ST
Provider Second Line Business Practice Location Address:
#110
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77071-2245
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-771-8362
Provider Business Practice Location Address Fax Number:
713-771-8364
Provider Enumeration Date:
06/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
TELLISON
Authorized Official First Name:
ANDREA
Authorized Official Middle Name:
MICHELLE
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
713-771-8362

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  006519196 , 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: 158099501 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 158099502 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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