Healthcare Provider Details

I. General information

NPI: 1942504709
Provider Name (Legal Business Name): BONAGE MEDICAL SUPPLY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/07/2011
Last Update Date: 08/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9101 LIPAN RD 105
HOUSTON TX
77063-5568
US

IV. Provider business mailing address

9101 LIPAN RD 105
HOUSTON TX
77063-5568
US

V. Phone/Fax

Practice location:
  • Phone: 713-278-2000
  • Fax: 713-278-2002
Mailing address:
  • Phone: 713-278-2000
  • Fax: 713-278-2002

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: MR. GOODNEWS BONAGE
Title or Position: PRESIDENT
Credential:
Phone: 713-278-2000