# LA BASE MEDICAL SUPPLY

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1629406756
- **Authorized official:** MR. CALLISTUS EZEAKOR (OWNER)
- **Authorized official phone:** (713) 518-9360

## Contact information

- **Practice address:** 9302 EAGLEWOOD GLEN TRL, HOUSTON, TX 77083-6285
- **Practice address phone:** (713) 518-9360
- **Practice address fax:** (281) 302-6897
- **Mailing address:** 7770 HIGHWAY 6 S \# 367, HOUSTON, TX 77083-3319
- **Mailing address phone:** (713) 518-9360
- **Mailing address fax:** (281) 302-6897

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | 1000491 | TX | Yes |

## Other

- **Enumeration date:** 10/29/2013
- **Last updated:** 10/29/2013