=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336379221
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ELIXIR SUPPLY & SERVICES, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/25/2009
-----------------------------------------------------
Last Update Date | 08/30/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9894 BISSONNET ST STE. 100-0
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77036-8239
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-988-8989
-----------------------------------------------------
Fax | 713-988-8989
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9894 BISSONNET ST SUITE 100-0
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77036-8239
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-988-8989
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. SUNNY ODEY IDIKU
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 713-988-8989
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number | 1000086
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------