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General NPI Number Information
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NPI Number | 1740479369
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Entity Type | Organization
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Legal Business Name | DE DIVINE CONNECTION MEDICAL SUPPLY INC
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Dates
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Enumeration Date | 10/19/2007
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Last Update Date | 02/08/2017
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Provider Practice Location Address
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Address Line | 10200 W AIRPORT BLVD STE 110
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City | STAFFORD
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State | TX
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Zip | 77477-3333
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Country | US
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Telephone | 281-933-9172
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Fax | 281-933-9172
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Provider Business Mailing Address
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Address Line | 10200 W AIRPORT BLVD STE 110
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City | STAFFORD
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State | TX
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Zip | 77477-3333
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Country | US
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Telephone | 281-933-9162
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Fax | 281-933-9172
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. ANTHONY ATUCHI
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Credential |
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Telephone | 281-933-9162
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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 | 332B00000X
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License Number State | TX
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