MEDICARE: SOUTH POST OAK MEDICAL SUPPLY 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	332BC3200X	Customized Equipment (DME)

General Provider Information

NPI Number	:	1609496132
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTH POST OAK MEDICAL SUPPLY LLC

Provider Business Mailing Address
First Line	:	14215 S POST OAK RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77045-5233
Country	:	US
Telephone Number	:	713-562-3195
Fax Number	:

Provider Business Practice Location Address
First Line	:	14206 S POST OAK RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77045-5234
Country	:	US
Telephone Number	:	713-562-3195
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	CHARLES AHAIWE
Credential	:
Telephone Number	:	713-562-3195

Provider Enumeration Date	:	04/24/2020
Last Update Date	:	09/03/2020

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