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General NPI Number Information
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NPI Number | 1740272764
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Entity Type | Organization
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Legal Business Name | GALAXY MEDICAL SUPPLY, LLC
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Dates
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Enumeration Date | 08/16/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 6430 RICHMOND AVE SUITE # 250-14
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City | HOUSTON
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State | TX
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Zip | 77057-5917
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Country | US
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Telephone | 713-974-4600
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Fax | 713-974-4602
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Provider Business Mailing Address
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Address Line | 6430 RICHMOND AVE SUITE # 250-14
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City | HOUSTON
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State | TX
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Zip | 77057-5917
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Country | US
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Telephone | 713-974-4600
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Fax | 713-974-4602
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | ENITAN OSAGIE ISIWELE
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Credential |
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Telephone | 713-974-4600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 0079993
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License Number State | TX
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