MEDICARE: 3RD ST MEDICAL SUPPLY 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	332B00000X	Durable Medical Equipment & Medical Supplies		CA

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	:	1669747390
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	3RD ST MEDICAL SUPPLY INC

Provider Business Mailing Address
First Line	:	5750 N SAM HOUSTON PKWY E
Second Line	:	SUITE 513
City	:	HOUSTON
State	:	TX
Zip	:	77032-4090
Country	:	US
Telephone Number	:	888-258-0602
Fax Number	:

Provider Business Practice Location Address
First Line	:	5750 N SAM HOUSTON PKWY E
Second Line	:	SUITE 513
City	:	HOUSTON
State	:	TX
Zip	:	77032-4090
Country	:	US
Telephone Number	:	888-258-0602
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	NOHA ABDELLATIF
Credential	:
Telephone Number	:	888-258-0602

Provider Enumeration Date	:	03/13/2012
Last Update Date	:	12/11/2013

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