Healthcare Provider Details

I. General information

NPI: 1679480354
Provider Name (Legal Business Name): SECOND SUPPLY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11011 S WILCREST DR # G210
HOUSTON TX
77099-4347
US

IV. Provider business mailing address

11011 S WILCREST DR # G210
HOUSTON TX
77099-4347
US

V. Phone/Fax

Practice location:
  • Phone: 929-810-0502
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: SYED MOHSIN
Title or Position: MANAGER
Credential:
Phone: 929-810-0502