Provider Demographics
NPI:1982649844
Name:TEXAS DURABLE MEDICAL CO
Entity Type:Organization
Organization Name:TEXAS DURABLE MEDICAL CO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:TELLISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-771-8362
Mailing Address - Street 1:8449 W BELLFORT ST
Mailing Address - Street 2:#110
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77071-2245
Mailing Address - Country:US
Mailing Address - Phone:713-771-8362
Mailing Address - Fax:713-771-8364
Practice Address - Street 1:8449 W BELLFORT ST
Practice Address - Street 2:#110
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77071-2245
Practice Address - Country:US
Practice Address - Phone:713-771-8362
Practice Address - Fax:713-771-8364
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-17
Last Update Date:2011-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX006519196332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX158099501Medicaid
TX158099502Medicaid
TX158099502Medicaid