Provider Demographics
NPI:1518658897
Name:MOMENTUM SUPPLY
Entity Type:Organization
Organization Name:MOMENTUM SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIE
Authorized Official - Middle Name:MARCUS
Authorized Official - Last Name:SEMIEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-729-2244
Mailing Address - Street 1:11406 CARSON FIELD LN
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77433-2292
Mailing Address - Country:US
Mailing Address - Phone:832-729-2244
Mailing Address - Fax:
Practice Address - Street 1:11406 CARSON FIELD LN
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77433-2292
Practice Address - Country:US
Practice Address - Phone:832-729-2244
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-17
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343800000XTransportation ServicesSecured Medical Transport (VAN)
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)