=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083635296
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | T & R MEDICAL SUPPLY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/22/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 505 N SAM HOUSTON PKWY E SUITE 275
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77060-4018
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-272-0218
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9310 MEADOW FORD CT
-----------------------------------------------------
City | HUMBLE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77396-3797
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-441-3284
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MR. TREMAYNE LAMONT RANDLE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 832-453-7573
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number | 0087636
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------