MEDICARE: AUDACIOUS ENTERPRISES 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	335E00000X	Prosthetic/Orthotic Supplier
2	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1609682491
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AUDACIOUS ENTERPRISES LLC

Provider Business Mailing Address
First Line	:	2823 SKERNE FOREST DR
Second Line	:
City	:	SPRING
State	:	TX
Zip	:	77373-2391
Country	:	US
Telephone Number	:	832-250-5137
Fax Number	:

Provider Business Practice Location Address
First Line	:	2823 SKERNE FOREST DR
Second Line	:
City	:	SPRING
State	:	TX
Zip	:	77373-2391
Country	:	US
Telephone Number	:	832-250-5137
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ASIA RENISE MAYO
Credential	:
Telephone Number	:	832-250-5137

Provider Enumeration Date	:	12/05/2024
Last Update Date	:	12/05/2024

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Directions to “AUDACIOUS ENTERPRISES LLC ” Practice Location

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