Provider Demographics
NPI:1972831279
Name:OBSEQUIOUS SYSTEMS LLC
Entity Type:Organization
Organization Name:OBSEQUIOUS SYSTEMS LLC
Other - Org Name:HOUSTON WELLNESS BOUTIQUE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:TRIBBLE
Authorized Official - Suffix:
Authorized Official - Credentials:CMF
Authorized Official - Phone:713-522-7465
Mailing Address - Street 1:4009 BELLAIRE BLVD
Mailing Address - Street 2:STE GG
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77025-1168
Mailing Address - Country:US
Mailing Address - Phone:713-522-7465
Mailing Address - Fax:832-218-2949
Practice Address - Street 1:4009 BELLAIRE BLVD
Practice Address - Street 2:STE GG
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77025-1168
Practice Address - Country:US
Practice Address - Phone:713-522-7465
Practice Address - Fax:832-218-2949
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-24
Last Update Date:2014-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0109381174400000X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty