Provider Demographics
NPI:1013110758
Name:HOUSTON ADVANCE MEDLINE MEDICAL SUPPLY
Entity Type:Organization
Organization Name:HOUSTON ADVANCE MEDLINE MEDICAL SUPPLY
Other - Org Name:HOUSTON ADVANCE MEDLINE MEDICAL SUPPLY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINITRATOR
Authorized Official - Prefix:
Authorized Official - First Name:EMMANUEL
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:LORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-772-1109
Mailing Address - Street 1:10103 FONDREN RD
Mailing Address - Street 2:STE 491
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77096-4556
Mailing Address - Country:US
Mailing Address - Phone:713-772-1109
Mailing Address - Fax:713-271-7744
Practice Address - Street 1:10103 FONDREN RD
Practice Address - Street 2:STE 491
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77096-4556
Practice Address - Country:US
Practice Address - Phone:713-772-1109
Practice Address - Fax:713-271-7744
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies