Provider Demographics
NPI:1831528744
Name:LYMPHEDEMA TECHNOLOGIES, INC.
Entity type:Organization
Organization Name:LYMPHEDEMA TECHNOLOGIES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:VANZUYT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-485-2273
Mailing Address - Street 1:10021 MAIN ST
Mailing Address - Street 2:B3B
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77025-5224
Mailing Address - Country:US
Mailing Address - Phone:713-669-1111
Mailing Address - Fax:
Practice Address - Street 1:10021 MAIN ST
Practice Address - Street 2:B3B
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77025
Practice Address - Country:US
Practice Address - Phone:713-669-1111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-01
Last Update Date:2019-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
TX1001278332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
530329OtherBCBS