MEDICARE: KINGSMITH MEDICAL 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

General Provider Information

NPI Number	:	1477481307
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KINGSMITH MEDICAL SUPPLY LLC

Provider Business Mailing Address
First Line	:	6776 SOUTHWEST FWY STE 580
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77074-2115
Country	:	US
Telephone Number	:	929-494-1034
Fax Number	:

Provider Business Practice Location Address
First Line	:	6776 SOUTHWEST FWY STE 580
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77074-2115
Country	:	US
Telephone Number	:	929-494-1034
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SHAFIK SIDIKI
Credential	:
Telephone Number	:	929-494-1034

Provider Enumeration Date	:	05/11/2026
Last Update Date	:	05/11/2026

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