MEDICARE: JERED KAINE CARAWAY CEO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies	1003442	TX

General Provider Information

NPI Number	:	1003653171
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JERED KAINE CARAWAY CEO

Provider Business Mailing Address
First Line	:	5823 VALKEITH DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77096-4838
Country	:	US
Telephone Number	:	713-906-7436
Fax Number	:

Provider Business Practice Location Address
First Line	:	8503 GULF FWY
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77017-5086
Country	:	US
Telephone Number	:	713-906-7436
Fax Number	:	713-955-9034

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/15/2024
Last Update Date	:	07/15/2024

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Directions to “ JERED KAINE CARAWAY CEO” Practice Location

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