Provider Demographics
NPI:1942060702
Name:ON THE GO MEDICAL SUPPLY LLC
Entity Type:Organization
Organization Name:ON THE GO MEDICAL SUPPLY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-914-6633
Mailing Address - Street 1:15910 PARK POETRY CT
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77433-1266
Mailing Address - Country:US
Mailing Address - Phone:888-914-6633
Mailing Address - Fax:
Practice Address - Street 1:2626 S LOOP W STE 238
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054-5643
Practice Address - Country:US
Practice Address - Phone:888-914-6633
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-20
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No251E00000XAgenciesHome Health
No335E00000XSuppliersProsthetic/Orthotic Supplier