Provider Demographics
NPI:1861566200
Name:ATEX MEDICAL SUPPLY LLC
Entity type:Organization
Organization Name:ATEX MEDICAL SUPPLY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:BOTWE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-859-6800
Mailing Address - Street 1:11838 SANDY STREAM DR
Mailing Address - Street 2:
Mailing Address - City:TOMBALL
Mailing Address - State:TX
Mailing Address - Zip Code:77375-7737
Mailing Address - Country:US
Mailing Address - Phone:832-515-4992
Mailing Address - Fax:
Practice Address - Street 1:11500 FM 1960 RD W
Practice Address - Street 2:SUITE 124
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77065-3608
Practice Address - Country:US
Practice Address - Phone:281-859-6800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-18
Last Update Date:2011-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX5872930001Medicare NSC