Healthcare Provider Details

I. General information

NPI: 1922288810
Provider Name (Legal Business Name): PRESIDO MEDICAL SUPPLY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2007
Last Update Date: 11/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14601 BELLAIRE BLVD STE 145
HOUSTON TX
77083-2540
US

IV. Provider business mailing address

14601 BELLAIRE BLVD STE 145
HOUSTON TX
77083-2540
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number0064410
License Number StateTX

VIII. Authorized Official

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