Healthcare Provider Details

I. General information

NPI: 1720349756
Provider Name (Legal Business Name): HSCC AFFILIATE GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2012
Last Update Date: 06/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6300 RICHMOND AVE SUITE 210 D
HOUSTON TX
77057-9998
US

IV. Provider business mailing address

5868 WESTHEIMER RD #453
HOUSTON TX
77057-9998
US

V. Phone/Fax

Practice location:
  • Phone: 832-370-7266
  • Fax: 713-975-8005
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: CHASITY LANDRY
Title or Position: ATTORNEY-IN-FACT
Credential:
Phone: 832-370-7266