MEDICARE: MEDWISE 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	0046761	TX

General Provider Information

NPI Number	:	1477987964
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDWISE LLC

Provider Business Mailing Address
First Line	:	350 N SAM HOUSTON PKWY E
Second Line	:	STE 271
City	:	HOUSTON
State	:	TX
Zip	:	77060-3333
Country	:	US
Telephone Number	:	713-934-4500
Fax Number	:	800-215-4840

Provider Business Practice Location Address
First Line	:	350 N SAM HOUSTON PKWY E
Second Line	:	STE 271
City	:	HOUSTON
State	:	TX
Zip	:	77060-3333
Country	:	US
Telephone Number	:	713-934-4500
Fax Number	:	800-215-4840

Authorized Official
Title or Position	:	BILLING ADMINISTRATOR
Name	:	MS. SONYA B LEBLANC
Credential	:
Telephone Number	:	713-934-4500

Provider Enumeration Date	:	09/03/2013
Last Update Date	:	03/13/2024

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