=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871762195
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | 1ST CHOICE MEDICAL EQUIPMENT
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/21/2008
-----------------------------------------------------
Last Update Date | 06/11/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 16903 RED OAK DR STE. 162
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77090-3914
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-589-5306
-----------------------------------------------------
Fax | 832-533-2160
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 16903 RED OAK DR STE. 162
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77090-3914
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-589-5306
-----------------------------------------------------
Fax | 832-533-2160
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MR. EDWIN DANIEL QUINTEROS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 713-589-5306
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number | 101666
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------