MEDICARE: PRESTIGE ONE MEDICAL SUPPLY

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	:	1720529852
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRESTIGE ONE MEDICAL SUPPLY

Provider Business Mailing Address
First Line	:	1108 GULF FWY S
Second Line	:	SUITE #270
City	:	LEAGUE CITY
State	:	TX
Zip	:	77573-5100
Country	:	US
Telephone Number	:	713-893-3073
Fax Number	:

Provider Business Practice Location Address
First Line	:	1108 GULF FWY S
Second Line	:	SUITE #270
City	:	LEAGUE CITY
State	:	TX
Zip	:	77573-5100
Country	:	US
Telephone Number	:	713-893-3073
Fax Number	:

Authorized Official
Title or Position	:	OWNER/CFO
Name	:	MR. COREY JAMAL JOHNA
Credential	:
Telephone Number	:	281-543-5649

Provider Enumeration Date	:	03/08/2017
Last Update Date	:	03/08/2017

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Directions to “PRESTIGE ONE MEDICAL SUPPLY ” Practice Location

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