804 Medical Supply LLC

Primary specialty

Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X

Legal business name

804 MEDICAL SUPPLY LLC

Practice address

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

Phone

(902) 608-6717

NPI assigned

Aug 27, 2026

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Alex Wilson

Title

Manager

Phone

(902) 608-6717

Specialties & licenses 2

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1787788800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1787788800000",
    "number": "1285542720",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11011 S WILCREST DR # G210",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770994347"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11011 S WILCREST DR # G210",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770994347",
            "telephone_number": "902-608-6717"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "804 MEDICAL SUPPLY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2026-08-27",
        "last_updated": "2026-08-27",
        "certification_date": "2026-08-27",
        "status": "A",
        "authorized_official_last_name": "WILSON",
        "authorized_official_first_name": "ALEX",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "902-608-6717"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Orthopaedic Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Physical Medicine & Rehabilitation Physician in Houston, TX
• Providers in Houston, TX by specialty
• Physical Medicine & Rehabilitation Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.

Verify at the official NPI Registry.