Provider Demographics
NPI:1225319510
Name:MISSION MEDICAL SUPPLY
Entity Type:Organization
Organization Name:MISSION MEDICAL SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MIMI
Authorized Official - Middle Name:
Authorized Official - Last Name:DO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-933-3902
Mailing Address - Street 1:10515 BELLAIRE BLVD
Mailing Address - Street 2:SUITE M
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77072-5234
Mailing Address - Country:US
Mailing Address - Phone:281-933-3902
Mailing Address - Fax:281-933-3949
Practice Address - Street 1:10515 BELLAIRE BLVD
Practice Address - Street 2:SUITE M
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77072-5234
Practice Address - Country:US
Practice Address - Phone:281-933-3902
Practice Address - Fax:281-933-3949
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MISSION MEDICAL SUPPLY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-08-31
Last Update Date:2013-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies