Provider Demographics
NPI:1255548053
Name:LUPS LLC DBA FOOT SOLUTIONS
Entity type:Organization
Organization Name:LUPS LLC DBA FOOT SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DARRELL
Authorized Official - Middle Name:
Authorized Official - Last Name:CLOUGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-522-4335
Mailing Address - Street 1:5318 KIRBY DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77005-1349
Mailing Address - Country:US
Mailing Address - Phone:713-522-4335
Mailing Address - Fax:713-529-5256
Practice Address - Street 1:5318 KIRBY DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77005-1349
Practice Address - Country:US
Practice Address - Phone:713-522-4335
Practice Address - Fax:713-529-5256
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2011-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXCPED2483332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX4615810001Medicare NSC