Provider Demographics
NPI:1568719383
Name:SUPPLY MEDICAL USA, LLC
Entity Type:Organization
Organization Name:SUPPLY MEDICAL USA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TERRELL
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:CARMON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-366-6279
Mailing Address - Street 1:4141 SOUTHWEST FWY STE 505B
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77027-7334
Mailing Address - Country:US
Mailing Address - Phone:713-366-6279
Mailing Address - Fax:713-960-1122
Practice Address - Street 1:4141 SOUTHWEST FWY STE 505B
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77027-7334
Practice Address - Country:US
Practice Address - Phone:713-366-6279
Practice Address - Fax:713-960-1122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-10
Last Update Date:2012-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies