Provider Demographics
NPI:1750999306
Name:KING ROSS MEDICAL SUPPLY
Entity type:Organization
Organization Name:KING ROSS MEDICAL SUPPLY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CEDRIC
Authorized Official - Middle Name:THURSTON
Authorized Official - Last Name:ROSS KING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:346-763-5935
Mailing Address - Street 1:5200 MITCHELLDALE ST STE F21
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77092-7221
Mailing Address - Country:US
Mailing Address - Phone:346-763-5935
Mailing Address - Fax:832-383-7385
Practice Address - Street 1:5200 MITCHELLDALE ST STE F21
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77092-7221
Practice Address - Country:US
Practice Address - Phone:346-763-5935
Practice Address - Fax:832-383-7385
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-20
Last Update Date:2020-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies