Provider Demographics
NPI:1013020965
Name:PATRICK ITA
Entity Type:Organization
Organization Name:PATRICK ITA
Other - Org Name:MASSPOINT MEDICAL EQUIPMENT & SUPPLIES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:ITA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-977-6100
Mailing Address - Street 1:6776 SOUTHWEST FWY
Mailing Address - Street 2:SUITE 270
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77074-2107
Mailing Address - Country:US
Mailing Address - Phone:713-977-6100
Mailing Address - Fax:
Practice Address - Street 1:6776 SOUTHWEST FWY
Practice Address - Street 2:SUITE 270
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77074-2107
Practice Address - Country:US
Practice Address - Phone:713-977-6100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-16
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0065369332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX170327402Medicaid
TX170327401Medicaid
4717270001Medicare NSC