MEDICARE: SPACE CENTER RESPIRATORY EQUIPMENT LLP

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	332BX2000X	Oxygen Equipment & Supplies (DME)	0053236	TX

General Provider Information

NPI Number	:	1912195066
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPACE CENTER RESPIRATORY EQUIPMENT LLP

Provider Business Mailing Address
First Line	:	17300 SATURN LN
Second Line	:	SUITE 108
City	:	HOUSTON
State	:	TX
Zip	:	77058-2261
Country	:	US
Telephone Number	:	281-488-4463
Fax Number	:	281-488-4465

Provider Business Practice Location Address
First Line	:	17300 SATURN LN
Second Line	:	SUITE 108
City	:	HOUSTON
State	:	TX
Zip	:	77058-2261
Country	:	US
Telephone Number	:	281-488-4463
Fax Number	:	281-488-4465

Authorized Official
Title or Position	:	CEO
Name	:	SUSAN C MORGAN
Credential	:
Telephone Number	:	281-488-4463

Provider Enumeration Date	:	10/12/2007
Last Update Date	:	11/25/2009

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