MEDICARE: JOVIC MEDICAL SUPPLY, INC

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	TXD0013711	TX

General Provider Information

NPI Number	:	1740377068
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOVIC MEDICAL SUPPLY, INC

Provider Business Mailing Address
First Line	:	12525 FONDREN RD STE I
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77035-5226
Country	:	US
Telephone Number	:	281-709-3207
Fax Number	:	713-771-4784

Provider Business Practice Location Address
First Line	:	12525 FONDREN RD STE I
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77035-5226
Country	:	US
Telephone Number	:	281-709-3207
Fax Number	:	713-771-4784

Authorized Official
Title or Position	:	PRESIDENT
Name	:	AMOS GBENJO
Credential	:
Telephone Number	:	281-709-3207

Provider Enumeration Date	:	10/06/2006
Last Update Date	:	08/22/2020

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