Healthcare Provider Details

I. General information

NPI: 1770409799
Provider Name (Legal Business Name): MEDIFORGE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2026
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12331 SWORD POINT CT
WILLIS TX
77378-3213
US

IV. Provider business mailing address

12331 SWORD POINT CT
WILLIS TX
77378-3213
US

V. Phone/Fax

Practice location:
  • Phone: 929-494-1034
  • Fax:
Mailing address:
  • Phone: 929-494-1034
  • Fax:

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: MARY FRANCES HEISE
Title or Position: OWNER
Credential:
Phone: 929-494-1034