Dynasty Global Footwear LLC

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

License

2483 Issued in TX

Legal business name

DYNASTY GLOBAL FOOTWEAR LLC

Practice address

5318 Kirby Dr
Houston, TX 77005-1349

Phone

(713) 521-3668

Fax

(713) 521-3668

NPI assigned

Oct 16, 2013

Organization subpart

No

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

Authorized official

Name

Darrell Clough

Title

General Manager

Phone

(713) 521-3668

Specialties & licenses 1

Addresses

Other names 1

• FOOT SOLUTIONS RICE VILLAGE Doing business as

Locations

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

{
    "created_epoch": "1381881600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1381881600000",
    "number": "1710315486",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1620 CENTRAL AVE",
            "address_2": "STE 202",
            "city": "CHEYENNE",
            "state": "WY",
            "postal_code": "820014557",
            "telephone_number": "713-521-3668",
            "fax_number": "713-521-3668"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5318 KIRBY DR",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770051349",
            "telephone_number": "713-521-3668",
            "fax_number": "713-521-3668"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DYNASTY GLOBAL FOOTWEAR LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-10-16",
        "last_updated": "2013-10-16",
        "status": "A",
        "authorized_official_last_name": "CLOUGH",
        "authorized_official_first_name": "DARRELL",
        "authorized_official_title_or_position": "GENERAL MANAGER",
        "authorized_official_telephone_number": "713-521-3668"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "TX",
            "license": "2483",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "FOOT SOLUTIONS RICE VILLAGE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Durable Medical Equipment & Medical Supplies in Houston, TX
• Providers in Houston, TX by specialty
• Durable Medical Equipment & Medical Supplies in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.