MEDICARE: GRATZ DURABLE MEDICAL EQUIPMENT INC

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	171WH0202X	Home Modifications Contractor
2	332B00000X	Durable Medical Equipment & Medical Supplies

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0000	OTHER		NO NUMBER AVAILABLE AT THIS TIME

General Provider Information

NPI Number	:	1033755897
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GRATZ DURABLE MEDICAL EQUIPMENT INC

Provider Business Mailing Address
First Line	:	11530 SLICK ROCK DR
Second Line	:
City	:	RICHMOND
State	:	TX
Zip	:	77406-1470
Country	:	US
Telephone Number	:	508-410-0512
Fax Number	:	281-783-6558

Provider Business Practice Location Address
First Line	:	7100 REGENCY SQUARE BLVD STE 252
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77036-3186
Country	:	US
Telephone Number	:	508-410-0512
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MR. EZE JOHN
Credential	:
Telephone Number	:	508-410-0512

Provider Enumeration Date	:	11/26/2019
Last Update Date	:	01/17/2020

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