=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912195066
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SPACE CENTER RESPIRATORY EQUIPMENT LLP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/12/2007
-----------------------------------------------------
Last Update Date | 11/25/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 17300 SATURN LN SUITE 108
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77058-2261
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-488-4463
-----------------------------------------------------
Fax | 281-488-4465
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 17300 SATURN LN SUITE 108
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77058-2261
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-488-4463
-----------------------------------------------------
Fax | 281-488-4465
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | SUSAN C MORGAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 281-488-4463
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332BX2000X
-----------------------------------------------------
Taxonomy Name | Oxygen Equipment & Supplies (DME)
-----------------------------------------------------
License Number | 0053236
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------