Healthcare Provider Details

I. General information

NPI: 1295745446
Provider Name (Legal Business Name): MITCHEL S WELCH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 05/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

514 CHURCH ST
CROSBY TX
77532-2723
US

IV. Provider business mailing address

PO BOX 893
CROSBY TX
77532-0893
US

V. Phone/Fax

Practice location:
  • Phone: 281-328-3400
  • Fax: 281-462-0818
Mailing address:
  • Phone: 281-328-3400
  • Fax: 281-462-0818

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number0086863
License Number StateTX

VIII. Authorized Official

Name: MR. MITCHEL SHANE WELCH
Title or Position: OWNER
Credential:
Phone: 281-328-3400