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General NPI Number Information
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NPI Number | 1699150946
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Entity Type | Organization
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Legal Business Name | MEDCO PLUS HEALTH, LLC
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Dates
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Enumeration Date | 07/29/2015
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Last Update Date | 07/29/2015
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Provider Practice Location Address
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Address Line | 820 FUGATE ST
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City | HOUSTON
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State | TX
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Zip | 77009-5010
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Country | US
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Telephone | 512-693-1016
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Fax | 713-456-2082
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Provider Business Mailing Address
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Address Line | PO BOX 7252
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City | HOUSTON
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State | TX
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Zip | 77248-7252
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Country | US
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Telephone | 512-693-1016
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Fax | 713-456-2082
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Authorized Official
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Title or Position | PRESIDENT/ADMINISTRATOR
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Name | MR. LUIS MEDRANO JR.
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Credential | J.D.
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Telephone | 512-693-1016
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number | 016761
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License Number State | TX
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