Provider Demographics
NPI:1710036660
Name:M.D. WAREHOUSE, INC.
Entity Type:Organization
Organization Name:M.D. WAREHOUSE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KELSEY
Authorized Official - Middle Name:GLYNN
Authorized Official - Last Name:SHULTS
Authorized Official - Suffix:
Authorized Official - Credentials:BA
Authorized Official - Phone:281-507-2156
Mailing Address - Street 1:PO BOX 161535
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78716-1535
Mailing Address - Country:US
Mailing Address - Phone:281-507-2156
Mailing Address - Fax:512-899-2910
Practice Address - Street 1:4899 MONTROSE BLVD APT 1903
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77006-6172
Practice Address - Country:US
Practice Address - Phone:281-507-2156
Practice Address - Fax:512-899-2910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies