Provider Demographics
NPI:1669611372
Name:MEDICAL DEPOT, INC
Entity type:Organization
Organization Name:MEDICAL DEPOT, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LEAH
Authorized Official - Middle Name:LORANE
Authorized Official - Last Name:KENNEDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-440-6017
Mailing Address - Street 1:7311 ARDMORE ST
Mailing Address - Street 2:BLDG A & B
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77054-4205
Mailing Address - Country:US
Mailing Address - Phone:713-440-6017
Mailing Address - Fax:713-747-9076
Practice Address - Street 1:7311 ARDMORE ST
Practice Address - Street 2:BLDG A & B
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054-4205
Practice Address - Country:US
Practice Address - Phone:713-440-6017
Practice Address - Fax:713-747-9076
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-19
Last Update Date:2009-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0104583332BC3200X, 332BP3500X, 332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0104583OtherTX DEPT OF HEALTH