MEDICARE: JANSEN 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	0075611	TX

General Provider Information

NPI Number	:	1811980527
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JANSEN MEDICAL SUPPLY, LLC

Provider Business Mailing Address
First Line	:	6125 W SAM HOUSTON PKWY N
Second Line	:	SUITE 201
City	:	HOUSTON
State	:	TX
Zip	:	77041-5129
Country	:	US
Telephone Number	:	713-896-4050
Fax Number	:	713-896-4080

Provider Business Practice Location Address
First Line	:	6125 W SAM HOUSTON PKWY N
Second Line	:	SUITE 201
City	:	HOUSTON
State	:	TX
Zip	:	77041-5129
Country	:	US
Telephone Number	:	713-896-4050
Fax Number	:	713-896-4080

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. JEFFREY A JANSEN
Credential	:
Telephone Number	:	713-896-4050

Provider Enumeration Date	:	08/27/2005
Last Update Date	:	08/22/2020

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