Organization
HOMEDEQ
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ALEXANDER RODGER KENNEDY (PRESIDENT)
(713) 748-6225
Entity
Organization
Contact information
Practice address
107 W WAY ST, SUITE 15, LAKE JACKSON, TX 77566-5219
(979) 297-3603
(979) 297-3693
Mailing address
PO BOX 25242, HOUSTON, TX 77265-5242
(713) 748-6225
(713) 747-9076
Taxonomy
Speciality
Code
Description
License number
State
332BX2000X
Oxygen Equipment & Supplies (DME)
Primary
00559252
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
55952
TX DEPT OF HEALTH LISC
TX
Enumeration date
09/28/2006
Last updated
08/22/2020
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