Healthcare Provider Details

I. General information

NPI: 1972607687
Provider Name (Legal Business Name): PBR MEDICAL SUPPLY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2006
Last Update Date: 09/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23415 GOOD DALE LN
SPRING TX
77373-7042
US

IV. Provider business mailing address

23415 GOOD DALE LN
SPRING TX
77373-7042
US

V. Phone/Fax

Practice location:
  • Phone: 832-978-4578
  • Fax: 832-375-0169
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MRS. TRISTA MOORE
Title or Position: OWNER
Credential:
Phone: 832-978-4578