Healthcare Provider Details

I. General information

NPI: 1356149652
Provider Name (Legal Business Name): KATY ORTHO SUPPLIES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2025
Last Update Date: 04/09/2025
Certification Date: 04/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4800 W 34TH ST STE C50K
HOUSTON TX
77092-6663
US

IV. Provider business mailing address

14222 KIMBERLEY LN APT 467
HOUSTON TX
77079-4820
US

V. Phone/Fax

Practice location:
  • Phone: 346-470-4993
  • Fax: 437-836-9717
Mailing address:
  • Phone: 346-470-4993
  • Fax: 437-836-9717

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 Code332BD1200X
TaxonomyDialysis Equipment & Supplies (DME)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332BN1400X
TaxonomyNursing Facility Supplies (DME)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: VICTOR JEROME LEE
Title or Position: CEO
Credential:
Phone: 346-470-4993