Provider Demographics
NPI:1619329323
Name:SPERO MEDICAL SUPPLY, A SERIES OF SPERO REHABILITATION, LLC
Entity Type:Organization
Organization Name:SPERO MEDICAL SUPPLY, A SERIES OF SPERO REHABILITATION, LLC
Other - Org Name:SPERO MEDICAL SUPPLY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:
Authorized Official - Last Name:BOUCHILLON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-395-9090
Mailing Address - Street 1:23225 KINGSLAND BLVD STE 600
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-3705
Mailing Address - Country:US
Mailing Address - Phone:281-395-9090
Mailing Address - Fax:
Practice Address - Street 1:23225 KINGSLAND BLVD STE 600
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-3705
Practice Address - Country:US
Practice Address - Phone:281-395-9090
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-06
Last Update Date:2016-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1001463332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies