Healthcare Provider Details

I. General information

NPI: 1255351060
Provider Name (Legal Business Name): PRESIDO MEDICAL SUPPLY SERVICE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 05/06/2024
Certification Date: 05/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6850 HIGHWAY 6 S # 121A
HOUSTON TX
77083-3302
US

IV. Provider business mailing address

6850 HIGHWAY 6 S # 121A
HOUSTON TX
77083-3302
US

V. Phone/Fax

Practice location:
  • Phone: 281-933-8700
  • Fax: 281-933-4992
Mailing address:
  • Phone: 281-827-5357
  • Fax: 281-933-4992

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: GODFREY UKOH
Title or Position: PRESIDENT
Credential:
Phone: 281-933-8700