Healthcare Provider Details

I. General information

NPI: 1194859629
Provider Name (Legal Business Name): ENTRAMED, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 02/25/2025
Certification Date: 02/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27905 COMMERCIAL PARK RD STE 240
TOMBALL TX
77375-6580
US

IV. Provider business mailing address

27905 COMMERCIAL PARK RD STE 240
TOMBALL TX
77375-6580
US

V. Phone/Fax

Practice location:
  • Phone: 713-955-2123
  • Fax: 281-742-2589
Mailing address:
  • Phone: 713-955-2123
  • Fax: 281-742-2589

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number0051466
License Number StateTX
# 4
Primary TaxonomyY
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number0051466
License Number StateTX

VIII. Authorized Official

Name: MR. JEREMY W CRABB
Title or Position: CO-CEO
Credential:
Phone: 817-600-6233