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General NPI Number Information
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NPI Number | 1992792584
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Entity Type | Organization
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Legal Business Name | STARLINE MEDICAL SUPPLY CO.
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Dates
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Enumeration Date | 09/29/2005
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Last Update Date | 09/26/2008
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Provider Practice Location Address
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Address Line | 2427 FM 1092 RD
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City | MISSOURI CITY
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State | TX
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Zip | 77459-1809
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Country | US
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Telephone | 281-208-2421
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Fax | 281-208-2419
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Provider Business Mailing Address
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Address Line | 2427 FM 1092 RD
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City | MISSOURI CITY
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State | TX
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Zip | 77459-1809
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Country | US
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Telephone | 281-208-2421
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Fax | 281-208-2419
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Authorized Official
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Title or Position | DIRECTOR OPERATIONS
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Name | MR. SYLVANUS OKORO KANU
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Credential | MBA
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Telephone | 281-208-2421
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BP3500X
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Taxonomy Name | Parenteral & Enteral Nutrition Supplies (DME)
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License Number | 0063183
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 0063183
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License Number State | TX
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