Provider Demographics
NPI:1760651897
Name:CHRISCILLIA MEDICAL SUPPLY INCORPORATED
Entity Type:Organization
Organization Name:CHRISCILLIA MEDICAL SUPPLY INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:PRISCILLIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MADUEKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-664-1673
Mailing Address - Street 1:6006 BELLAIRE BLVD STE 216
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77081-5439
Mailing Address - Country:US
Mailing Address - Phone:713-664-1673
Mailing Address - Fax:713-664-1674
Practice Address - Street 1:6006 BELLAIRE BLVD STE 216
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77081-5439
Practice Address - Country:US
Practice Address - Phone:713-664-1673
Practice Address - Fax:713-664-1674
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-22
Last Update Date:2008-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0088192332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX193795501Medicaid
TX193795503Medicaid
TX193795502Medicaid
TX193795503Medicaid