MEDICARE: MR. ERIC D HENRY SR.

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	1000296	TX

General Provider Information

NPI Number	:	1447561253
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ERIC D HENRY SR.

Provider Business Mailing Address
First Line	:	13940 BAMMEL NORTH HOUSTON
Second Line	:	SUITE 303
City	:	HOUSTON
State	:	TX
Zip	:	77066-2950
Country	:	US
Telephone Number	:	281-580-4400
Fax Number	:	281-580-4432

Provider Business Practice Location Address
First Line	:	13940 BAMMEL NORTH HOUSTON
Second Line	:	SUITE 303
City	:	HOUSTON
State	:	TX
Zip	:	77066-2950
Country	:	US
Telephone Number	:	281-580-4400
Fax Number	:	281-580-4432

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/25/2010
Last Update Date	:	06/25/2010

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