=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760704530
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | C&O MEDICAL SUPPLY SERVICES INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/22/2010
-----------------------------------------------------
Last Update Date | 02/22/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12999 MURPHY RD M-16
-----------------------------------------------------
City | STAFFORD
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77477-3955
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-495-7440
-----------------------------------------------------
Fax | 281-495-7440
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12999 MURPHY RD M-16
-----------------------------------------------------
City | STAFFORD
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77477-3955
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-495-7440
-----------------------------------------------------
Fax | 281-495-7440
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | OSAYANDE IDUGBOE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 281-495-7440
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------