Provider Demographics
NPI:1033309000
Name:ESSENTIAL MEDICAL SUPPLY
Entity Type:Organization
Organization Name:ESSENTIAL MEDICAL SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MFON
Authorized Official - Middle Name:OKON
Authorized Official - Last Name:ENYONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-595-1290
Mailing Address - Street 1:1106 MORTON STREET
Mailing Address - Street 2:F
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77469
Mailing Address - Country:US
Mailing Address - Phone:832-595-1290
Mailing Address - Fax:832-595-1292
Practice Address - Street 1:1106 MORTON STREET
Practice Address - Street 2:F
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77469
Practice Address - Country:US
Practice Address - Phone:832-595-1290
Practice Address - Fax:832-595-1292
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-26
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14184332BP3500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX6032470001Medicare NSC