Healthcare Provider Details

I. General information

NPI: 1568485456
Provider Name (Legal Business Name): GULF BIOMECHANICAL LABORATORY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 04/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6801 MCPHERSON RD SUITE 222
LAREDO TX
78041-6402
US

IV. Provider business mailing address

4045 E SOUTHCROSS BLVD
SAN ANTONIO TX
78222-3636
US

V. Phone/Fax

Practice location:
  • Phone: 956-722-6487
  • Fax: 956-722-6366
Mailing address:
  • Phone: 210-495-3999
  • Fax: 210-495-3393

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number101167
License Number StateTX

VIII. Authorized Official

Name: ANTHONY E MYERS
Title or Position: OWNER
Credential: L.P.O.
Phone: 210-495-3399