1700961356 NPI number — ON TIME MEDICAL SUPPLIES

Table of content: (NPI 1700961356)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700961356 NPI number — ON TIME MEDICAL SUPPLIES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ON TIME MEDICAL SUPPLIES
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:
1700961356
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/11/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14455 CULLEN BLVD
Provider Second Line Business Mailing Address:
SUITE C1
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77047-4800
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-731-0880
Provider Business Mailing Address Fax Number:
713-731-2005

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14455 CULLEN BLVD
Provider Second Line Business Practice Location Address:
SUITE C1
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77047-4800
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-731-0880
Provider Business Practice Location Address Fax Number:
713-731-2005
Provider Enumeration Date:
10/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MORRIS
Authorized Official First Name:
MEDRICK
Authorized Official Middle Name:
MASON
Authorized Official Title or Position:
CHIEF FINANCIAL OFFICER
Authorized Official Telephone Number:
713-443-8003

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  92761 , 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: 2147738-02DM2 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2147738-01CCP , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com