MEDICARE: FIRST CLASS MEDICAL EQUIPMENT AND 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	332BX2000X	Oxygen Equipment & Supplies (DME)	0062942	TX
2	332B00000X	Durable Medical Equipment & Medical Supplies	TX 14425	TX
3	332B00000X	Durable Medical Equipment & Medical Supplies	0062942	TX

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	531963	OTHER	TX	BCBS TX PROVIDER NUMBER

General Provider Information

NPI Number	:	1750389052
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FIRST CLASS MEDICAL EQUIPMENT AND SUPPLY, INC.

Provider Business Mailing Address
First Line	:	55 LYERLY ST
Second Line	:	SUITE 300
City	:	HOUSTON
State	:	TX
Zip	:	77022-3062
Country	:	US
Telephone Number	:	713-696-9363
Fax Number	:	713-696-9321

Provider Business Practice Location Address
First Line	:	55 LYERLY ST
Second Line	:	SUITE 300
City	:	HOUSTON
State	:	TX
Zip	:	77022-3062
Country	:	US
Telephone Number	:	713-696-9363
Fax Number	:	713-696-9321

Authorized Official
Title or Position	:	OPERATIONS DIRECTOR
Name	:	MR. DAVID HEATON
Credential	:
Telephone Number	:	713-696-9363

Provider Enumeration Date	:	07/11/2005
Last Update Date	:	06/19/2015

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