Healthcare Provider Details

I. General information

NPI: 1912180126
Provider Name (Legal Business Name): AB & MJ CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2007
Last Update Date: 11/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9705 BURNET RD STE 204
AUSTIN TX
78758-5242
US

IV. Provider business mailing address

2566 MACARTHUR VIEW
SAN ANTONIO TX
78217-4448
US

V. Phone/Fax

Practice location:
  • Phone: 512-821-1879
  • Fax: 512-821-0995
Mailing address:
  • Phone: 210-340-1055
  • Fax: 210-340-1266

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number0100905
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number0100905
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number0100905
License Number StateTX

VIII. Authorized Official

Name: DOUGLAS KRUG
Title or Position: CEO
Credential:
Phone: 210-340-1055