Provider Demographics
NPI:1972048064
Name:MEDINOVA, INC.
Entity Type:Organization
Organization Name:MEDINOVA, INC.
Other - Org Name:SUGAR LAND MEDICAL SUPPLY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:NISHAT
Authorized Official - Middle Name:
Authorized Official - Last Name:VAZIR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-201-2400
Mailing Address - Street 1:16126 SOUTHWEST FWY
Mailing Address - Street 2:SUITE # 100
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-2638
Mailing Address - Country:US
Mailing Address - Phone:281-201-2400
Mailing Address - Fax:
Practice Address - Street 1:16126 SOUTHWEST FWY
Practice Address - Street 2:SUITE # 100
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-2638
Practice Address - Country:US
Practice Address - Phone:281-201-2400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-27
Last Update Date:2016-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1001218332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies