MEDICARE: MYKYTYN 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	0073397	TX

General Provider Information

NPI Number	:	1861498081
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MYKYTYN MEDICAL SUPPLY

Provider Business Mailing Address
First Line	:	375 MAXEY RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77013-4545
Country	:	US
Telephone Number	:	713-451-4462
Fax Number	:	713-451-8330

Provider Business Practice Location Address
First Line	:	375 MAXEY RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77013-4545
Country	:	US
Telephone Number	:	713-451-4462
Fax Number	:	713-451-8330

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. SCHURA CHRISTINE NORMAND
Credential	:
Telephone Number	:	713-451-4462

Provider Enumeration Date	:	06/22/2005
Last Update Date	:	06/18/2008

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