=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528202850
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JP MEDICAL SUPPLY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/30/2009
-----------------------------------------------------
Last Update Date | 07/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8700 COMMERCE PARK DR STE 205
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77036-7430
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-995-6600
-----------------------------------------------------
Fax | 713-995-6602
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8700 COMMERCE PARK DR. STE. 205
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77036
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-995-6600
-----------------------------------------------------
Fax | 713-995-6602
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/DIRECTOR OF OPERATIONS
-----------------------------------------------------
Name | MRS. CHIKA IWUCHUKWU
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 713-995-6600
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number | 15
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------