Provider Demographics
NPI:1003653171
Name:CARAWAY, JERED KAINE (CEO)
Entity type:Individual
Prefix:
First Name:JERED
Middle Name:KAINE
Last Name:CARAWAY
Suffix:
Gender:M
Credentials:CEO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5823 VALKEITH DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77096-4838
Mailing Address - Country:US
Mailing Address - Phone:713-906-7436
Mailing Address - Fax:
Practice Address - Street 1:8503 GULF FWY
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77017-5086
Practice Address - Country:US
Practice Address - Phone:713-906-7436
Practice Address - Fax:713-955-9034
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-15
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1003442332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies