=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720301401
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AMIGOMED, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/09/2010
-----------------------------------------------------
Last Update Date | 02/05/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12808 W. AIRPORT 325 C
-----------------------------------------------------
City | SUGAR LAND
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77478
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-302-6027
-----------------------------------------------------
Fax | 832-886-4268
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12808 W. AIRPORT SUITE 325 C
-----------------------------------------------------
City | SUGAR LAND
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77478
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-302-6027
-----------------------------------------------------
Fax | 832-886-4268
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. PEARY PERRY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 281-302-6027
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number | 1000364
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------