Organization · NPI-2

804 Medical Supply LLC

Physical Medicine & Rehabilitation · Houston, TX

NPI number1285542720
StatusActive
Last updated in NPPESAug 27, 2026

Details

NPI
1285542720
Entity type
Organization (NPI-2)
Legal business name
804 Medical Supply LLC
Organization subpart
No
Enumeration date
Aug 27, 2026
Certification date
Aug 27, 2026
Last updated
Aug 27, 2026

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
208100000X Physical Medicine & Rehabilitation––Yes
207X00000X Orthopaedic Surgery––

Practice location

11011 S Wilcrest Dr # G210
Houston, TX 77099-4347

Phone 902-608-6717

Mailing address

11011 S Wilcrest Dr # G210
Houston, TX 77099-4347

Authorized official

Alex Wilson
Manager
9026086717

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