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NPI Code Detail

MEDICARE: PD SUPPLIERS OF TEXAS

MEDICARE: PD SUPPLIERS OF TEXAS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1332BD1200XDialysis Equipment & Supplies (DME)TX

General Provider Information

NPI Number : 1093776379
Entity Type Code : Organization
Provider Name (Legal Business Name) : PD SUPPLIERS OF TEXAS
Provider Business Mailing Address
First Line : PO BOX 5780
Second Line :
City : SAN ANGELO
State : TX
Zip : 76902-5780
Country : US
Telephone Number : 325-653-6773
Fax Number :
Provider Business Practice Location Address
First Line : 136 E CONCHO AVE
Second Line :
City : SAN ANGELO
State : TX
Zip : 76903-5947
Country : US
Telephone Number : 325-653-6773
Fax Number :
Authorized Official
Title or Position : BILLING SUPERVISOR
Name : NORA HERNANDEZ
Credential :
Telephone Number : 325-653-6773
Provider Enumeration Date : 03/28/2006
Last Update Date : 02/17/2014

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Directions to “PD SUPPLIERS OF TEXAS ” Practice Location

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