Provider Demographics
NPI:1922288810
Name:PRESIDO MEDICAL SUPPLY SERVICES
Entity Type:Organization
Organization Name:PRESIDO MEDICAL SUPPLY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GODFREY
Authorized Official - Middle Name:O
Authorized Official - Last Name:UKOH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-933-8700
Mailing Address - Street 1:14601 BELLAIRE BLVD
Mailing Address - Street 2:STE 145
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77083-2540
Mailing Address - Country:US
Mailing Address - Phone:281-933-8700
Mailing Address - Fax:281-933-4992
Practice Address - Street 1:14601 BELLAIRE BLVD
Practice Address - Street 2:STE 145
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77083-2540
Practice Address - Country:US
Practice Address - Phone:281-933-8700
Practice Address - Fax:281-933-4992
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-07
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0064410332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX4620700001Medicare NSC