=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205212867
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EULORACE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/06/2015
-----------------------------------------------------
Last Update Date | 08/06/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2929 ALLEN PKWY
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77019-7100
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-821-6042
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2929 ALLEN PKWY
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77019-7100
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-821-6042
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEMBER
-----------------------------------------------------
Name | MR. JASON RIDGEL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 832-821-6042
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------