MEDICARE: WILCREST CPAP'S

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1215479142
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WILCREST CPAP'S

Provider Business Mailing Address
First Line	:	12000 WILCREST DR
Second Line	:	204
City	:	HOUSTON
State	:	TX
Zip	:	77031-1924
Country	:	US
Telephone Number	:	281-871-0104
Fax Number	:	832-847-8553

Provider Business Practice Location Address
First Line	:	12000 WILCREST DR
Second Line	:	204
City	:	HOUSTON
State	:	TX
Zip	:	77031-1924
Country	:	US
Telephone Number	:	281-871-0104
Fax Number	:	832-813-5070

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	JOSEPH FONGUM
Credential	:
Telephone Number	:	281-871-0104

Provider Enumeration Date	:	11/09/2016
Last Update Date	:	11/09/2016

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