Provider Demographics
NPI:1558416164
Name:PVT HEALTH CARE & MEDICAL SUPPLY SERVICES
Entity Type:Organization
Organization Name:PVT HEALTH CARE & MEDICAL SUPPLY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GBENGA
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:FADIPE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-271-0339
Mailing Address - Street 1:9207 COUNTRY CREEK DR STE 106
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77036-7711
Mailing Address - Country:US
Mailing Address - Phone:713-271-0339
Mailing Address - Fax:
Practice Address - Street 1:9207 COUNTRY CREEK DR STE 106
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-7711
Practice Address - Country:US
Practice Address - Phone:713-271-0339
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0092790332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies