MEDICARE: PM SUPPLY LLC

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	0086700	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063474542
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PM SUPPLY LLC

Provider Business Mailing Address
First Line	:	8313 SOUTHWEST FWY
Second Line	:	STE 223
City	:	HOUSTON
State	:	TX
Zip	:	77074-1612
Country	:	US
Telephone Number	:	713-270-8183
Fax Number	:	713-270-8175

Provider Business Practice Location Address
First Line	:	8313 SOUTHWEST FWY
Second Line	:	STE 223
City	:	HOUSTON
State	:	TX
Zip	:	77074-1612
Country	:	US
Telephone Number	:	713-270-8183
Fax Number	:	713-270-8175

Authorized Official
Title or Position	:	GENERAL MANAGER
Name	:	MR. DERWIN WARE
Credential	:	CPED
Telephone Number	:	713-270-8183

Provider Enumeration Date	:	04/03/2006
Last Update Date	:	06/13/2008

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Directions to “PM SUPPLY LLC ” Practice Location

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