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General NPI Number Information
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NPI Number | 1154584001
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Entity Type | Organization
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Legal Business Name | TEXAS REJUVENATION MEDICAL SUPPLY, LLC
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Dates
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Enumeration Date | 07/09/2008
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Last Update Date | 09/24/2012
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Provider Practice Location Address
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Address Line | 414 W. GRAND PKWY S., STE B-150
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City | KATY
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State | TX
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Zip | 77494
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Country | US
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Telephone | 281-564-9332
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Fax | 281-564-0015
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Provider Business Mailing Address
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Address Line | 414 W. GRAND PKWY S., STE B-150
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City | KATY
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State | TX
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Zip | 77494
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Country | US
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Telephone | 281-564-9332
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Fax | 281-564-0015
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Authorized Official
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Title or Position | OWNER
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Name | MR. WILLIAM D SMYTHE
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Credential |
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Telephone | 281-564-9332
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | TX14767
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License Number State | TX
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