MEDICARE: DYNASTY GLOBAL FOOTWEAR 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	2483	TX

General Provider Information

NPI Number	:	1710315486
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DYNASTY GLOBAL FOOTWEAR LLC

Provider Business Mailing Address
First Line	:	1620 CENTRAL AVE
Second Line	:	STE 202
City	:	CHEYENNE
State	:	WY
Zip	:	82001-4557
Country	:	US
Telephone Number	:	713-521-3668
Fax Number	:	713-521-3668

Provider Business Practice Location Address
First Line	:	5318 KIRBY DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77005-1349
Country	:	US
Telephone Number	:	713-521-3668
Fax Number	:	713-521-3668

Authorized Official
Title or Position	:	GENERAL MANAGER
Name	:	DARRELL CLOUGH
Credential	:
Telephone Number	:	713-521-3668

Provider Enumeration Date	:	10/16/2013
Last Update Date	:	10/16/2013

Similar Medicare Providers

1255548053 — LUPS LLC DBA FOOT SOLUTIONS
Practice Location Address:

5318 KIRBY DR
HOUSTON, TX
77005-1349

Practice Phone: 713-522-4335
Practice Fax: 713-529-5256

1790610798 — MARQIN ALAYNA COOK LPC, ATR-BC
Practice Location Address:

2012 TUAM ST
HOUSTON, TX
77004-1349

Practice Phone: 941-769-1170
Practice Fax:

1699834804 — MICHAEL ROBERT SELL DDS
Practice Location Address:

1349 S VOSS
HOUSTON, TX
77057

Practice Phone: 713-780-4507
Practice Fax: 713-780-9537

1457413775 — DR. AUGUSTUS T FAHNBULLEH SR. M.D.
Practice Location Address:

9601 KATY FWY STE 260
HOUSTON, TX
77024-1349

Practice Phone: 713-979-0251
Practice Fax:

1275735680 — DR. ISABEL ANN CRUZ OD
Practice Location Address:

415 W LITTLE YORK RD , STE E
HOUSTON, TX
77076-1349

Practice Phone: 713-699-2020
Practice Fax: 713-697-2016

1740469550 — ISABEL A. CRUZ OD PA
Practice Location Address:

415 W LITTLE YORK RD , STE E
HOUSTON, TX
77076-1349

Practice Phone: 713-699-2020
Practice Fax: 713-697-2016

Directions to “DYNASTY GLOBAL FOOTWEAR LLC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.