Provider Demographics
NPI:1487739967
Name:PRAISE DME SUPPLIES
Entity type:Organization
Organization Name:PRAISE DME SUPPLIES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATION
Authorized Official - Prefix:
Authorized Official - First Name:EKPEDEME
Authorized Official - Middle Name:
Authorized Official - Last Name:OBOT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-972-9149
Mailing Address - Street 1:6201 BONHOMME RD
Mailing Address - Street 2:187N
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77036-4365
Mailing Address - Country:US
Mailing Address - Phone:713-972-9149
Mailing Address - Fax:713-972-9151
Practice Address - Street 1:6201 BONHOMME RD
Practice Address - Street 2:187N
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-4365
Practice Address - Country:US
Practice Address - Phone:713-972-9149
Practice Address - Fax:713-972-9151
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0077954332BP3500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX177666801Medicaid
TX177666801Medicaid