Healthcare Provider Details

I. General information

NPI: 1659748200
Provider Name (Legal Business Name): 50 PULMONARY SYSTEMS INTEGRATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2015
Last Update Date: 09/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8822 BASKOVE DR
HOUSTON TX
77088-1435
US

IV. Provider business mailing address

10838 KIRKTOWN DR
HOUSTON TX
77089-3029
US

V. Phone/Fax

Practice location:
  • Phone: 832-308-0010
  • Fax:
Mailing address:
  • Phone: 832-308-0010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number
License Number StateTX

VIII. Authorized Official

Name: MRS. AQUINAS CHERI JACKSON
Title or Position: CO-OWNER
Credential: RCP, RRT-NPS
Phone: 713-806-2095