Organization
EMPIRE MEDICAL SUPPLY INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. ENOBONG I EDWARD (DIRECTOR)
(281) 403-2595
Entity
Organization
Contact information
Practice address
13955 MURPHY RD, SUITE 205, STAFFORD, TX 77477-4920
(281) 403-2595
(281) 403-2624
Mailing address
PO BOX 2546, STAFFORD, TX 77497-2546
(281) 403-2595
(281) 403-2624
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
0062812
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
278639
AMERIGROUP
TX
Enumeration date
07/01/2006
Last updated
08/22/2020
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