Provider Demographics
NPI:1053303586
Name:BACK TO BACK MEDICAL EQUIPMENT DIST
Entity Type:Organization
Organization Name:BACK TO BACK MEDICAL EQUIPMENT DIST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:II
Authorized Official - Credentials:
Authorized Official - Phone:713-270-6403
Mailing Address - Street 1:6440 HILLCROFT ST
Mailing Address - Street 2:6440 HILLCROFT AVE STE #112
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77081-3104
Mailing Address - Country:US
Mailing Address - Phone:713-270-6403
Mailing Address - Fax:713-270-6860
Practice Address - Street 1:6440 HILLCROFT ST
Practice Address - Street 2:6440 HILLCROFT AVE STE #112
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77081-3104
Practice Address - Country:US
Practice Address - Phone:713-270-6403
Practice Address - Fax:713-270-6860
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0075614332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX5226940001Medicaid