Healthcare Provider Details

I. General information

NPI: 1013643543
Provider Name (Legal Business Name): ENTRAMED, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2022
Last Update Date: 07/27/2022
Certification Date: 07/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

412 N 4TH ST # 331A
BATON ROUGE LA
70802-5523
US

IV. Provider business mailing address

27905 COMMERCIAL PARK RD STE 240
TOMBALL TX
77375-6580
US

V. Phone/Fax

Practice location:
  • Phone: 225-819-3732
  • Fax:
Mailing address:
  • Phone: 713-955-2123
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: JEREMY CRABB
Title or Position: CEO
Credential:
Phone: 713-955-2123