Provider Demographics
NPI:1700961356
Name:ON TIME MEDICAL SUPPLIES
Entity type:Organization
Organization Name:ON TIME MEDICAL SUPPLIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:MEDRICK
Authorized Official - Middle Name:MASON
Authorized Official - Last Name:MORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-443-8003
Mailing Address - Street 1:14455 CULLEN BLVD
Mailing Address - Street 2:SUITE C1
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77047-4800
Mailing Address - Country:US
Mailing Address - Phone:713-731-0880
Mailing Address - Fax:713-731-2005
Practice Address - Street 1:14455 CULLEN BLVD
Practice Address - Street 2:SUITE C1
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77047-4800
Practice Address - Country:US
Practice Address - Phone:713-731-0880
Practice Address - Fax:713-731-2005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX92761332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2147738-02DM2Medicaid
TX2147738-01CCPMedicaid
TX2147738-02DM2Medicaid