MEDICARE: SENIOR'S PAIN RELIEF 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	:	1871775205
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SENIOR'S PAIN RELIEF MEDICAL SUPPLY

Provider Business Mailing Address
First Line	:	20807 FOX CLIFF LN
Second Line	:
City	:	HUMBLE
State	:	TX
Zip	:	77338-6718
Country	:	US
Telephone Number	:	832-229-9943
Fax Number	:	281-446-7223

Provider Business Practice Location Address
First Line	:	16711 N MIST DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77073-5254
Country	:	US
Telephone Number	:	832-229-9943
Fax Number	:	281-446-7223

Authorized Official
Title or Position	:	OWNER
Name	:	MR. JUAN PABLO LOPEZ
Credential	:
Telephone Number	:	832-229-9943

Provider Enumeration Date	:	11/27/2007
Last Update Date	:	11/28/2007

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