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General NPI Number Information
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NPI Number | 1558539684
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Entity Type | Organization
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Legal Business Name | SOUTHERN MEDIC DURABLE EQUIPMENT
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Dates
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Enumeration Date | 02/11/2008
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Last Update Date | 10/28/2008
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Provider Practice Location Address
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Address Line | 10101 HARWIN DR STE. 369
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City | HOUSTON
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State | TX
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Zip | 77036-1687
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Country | US
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Telephone | 713-271-3884
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Fax | 832-252-1925
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Provider Business Mailing Address
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Address Line | 10101 HARWIN DR STE. 369
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City | HOUSTON
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State | TX
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Zip | 77036-1687
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Country | US
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Telephone | 713-271-3884
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Fax | 832-252-1925
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Authorized Official
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Title or Position | OWNER
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Name | DEANDRIA MERRLEN WOOD
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Credential |
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Telephone | 713-271-3884
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BP3500X
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Taxonomy Name | Parenteral & Enteral Nutrition Supplies (DME)
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License Number | 102259
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License Number State | TX
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