MEDICARE: CONQUEST DME LLC

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	:	1306456157
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CONQUEST DME LLC

Provider Business Mailing Address
First Line	:	12929 JESS PIRTLE BLVD STE 250
Second Line	:
City	:	SUGAR LAND
State	:	TX
Zip	:	77478-2851
Country	:	US
Telephone Number	:	281-637-2221
Fax Number	:

Provider Business Practice Location Address
First Line	:	12929 JESS PIRTLE BLVD STE 250
Second Line	:
City	:	SUGAR LAND
State	:	TX
Zip	:	77478-2851
Country	:	US
Telephone Number	:	281-637-2221
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	JANE WILKERSON-BUNCH
Credential	:
Telephone Number	:	770-366-0644

Provider Enumeration Date	:	08/06/2020
Last Update Date	:	08/06/2020

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Directions to “CONQUEST DME LLC ” Practice Location

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