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NPI Code Detail

MEDICARE: MEDICAL DEPOT, INC

MEDICARE: MEDICAL DEPOT, 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
1332BC3200XCustomized Equipment (DME)0104583TX
2332BP3500XParenteral & Enteral Nutrition Supplies (DME)0104583TX
3332BX2000XOxygen Equipment & Supplies (DME)0104583TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
10104583OTHERTXTX DEPT OF HEALTH

General Provider Information

NPI Number : 1669611372
Entity Type Code : Organization
Provider Name (Legal Business Name) : MEDICAL DEPOT, INC
Provider Business Mailing Address
First Line : 7311 ARDMORE ST
Second Line : BLDG A & B
City : HOUSTON
State : TX
Zip : 77054-4205
Country : US
Telephone Number : 713-440-6017
Fax Number : 713-747-9076
Provider Business Practice Location Address
First Line : 7311 ARDMORE ST
Second Line : BLDG A & B
City : HOUSTON
State : TX
Zip : 77054-4205
Country : US
Telephone Number : 713-440-6017
Fax Number : 713-747-9076
Authorized Official
Title or Position : OWNER
Name : LEAH LORANE KENNEDY
Credential :
Telephone Number : 713-440-6017
Provider Enumeration Date : 02/19/2009
Last Update Date : 02/19/2009

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Directions to “MEDICAL DEPOT, INC ” Practice Location

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