MEDICARE: ODYSSEY MANAGEMENT SUPPLIES 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	1001580	TX

General Provider Information

NPI Number	:	1265817118
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ODYSSEY MANAGEMENT SUPPLIES LLC

Provider Business Mailing Address
First Line	:	1846 SNAKE RIVER RD STE B
Second Line	:
City	:	KATY
State	:	TX
Zip	:	77449-7758
Country	:	US
Telephone Number	:	281-945-2145
Fax Number	:	888-330-7541

Provider Business Practice Location Address
First Line	:	1846 SNAKE RIVER RD STE B
Second Line	:
City	:	KATY
State	:	TX
Zip	:	77449-7758
Country	:	US
Telephone Number	:	281-945-2145
Fax Number	:	888-330-7541

Authorized Official
Title or Position	:	MANAGER
Name	:	MARCUS LEWIS
Credential	:
Telephone Number	:	281-945-2145

Provider Enumeration Date	:	07/21/2015
Last Update Date	:	07/21/2015

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