804 Medical Supply LLC

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

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

Last updated

Aug 27, 2026By the provider in NPPES

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 1

Addresses

Tax ID family

804 Medical Supply LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• 804 Medical Supply LLC

  • Physical Medicine & Rehabilitation Physician
  • Houston, TX
  • NPI 1285542720
  NPD tax ID

Locations

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": "1790693232",
    "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": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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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 Aug 27, 2026; 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.