Provider Demographics
NPI:1629344866
Name:MDS MEDICAL DIAGNOSTIC AND SUPPLIES LLC
Entity Type:Organization
Organization Name:MDS MEDICAL DIAGNOSTIC AND SUPPLIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BILLY
Authorized Official - Middle Name:ADISA
Authorized Official - Last Name:AYOOLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-955-3377
Mailing Address - Street 1:PO BOX 692312
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77269-2312
Mailing Address - Country:US
Mailing Address - Phone:281-955-3377
Mailing Address - Fax:281-955-3424
Practice Address - Street 1:11706 FALLBROOK DR
Practice Address - Street 2:SUITE B
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77065-3510
Practice Address - Country:US
Practice Address - Phone:281-955-3377
Practice Address - Fax:281-955-3424
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-30
Last Update Date:2012-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1000715332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies