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General NPI Number Information
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NPI Number | 1285185165
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Entity Type | Organization
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Legal Business Name | MEDISOUTH INC.
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Dates
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Enumeration Date | 10/17/2016
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Last Update Date | 10/17/2016
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Provider Practice Location Address
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Address Line | 6229 THEALL RD A
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City | HOUSTON
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State | TX
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Zip | 77066-1319
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Country | US
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Telephone | 832-533-2646
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Fax |
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Provider Business Mailing Address
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Address Line | 6229 THEALL RD A
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City | HOUSTON
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State | TX
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Zip | 77066-1319
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Country | US
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Telephone | 832-533-2646
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Fax |
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | MR. GREG STADLER
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Credential |
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Telephone | 832-533-2646
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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 | 1000298
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License Number State | TX
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