Healthcare Provider Details

I. General information

NPI: 1932172715
Provider Name (Legal Business Name): AMERICAN HOME MEDICAL SUPPLY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2006
Last Update Date: 08/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5918 MCPHERSON RD STE 4
LAREDO TX
78041-6159
US

IV. Provider business mailing address

1011 E 7TH ST
DEL RIO TX
78840-4162
US

V. Phone/Fax

Practice location:
  • Phone: 956-712-2273
  • Fax: 956-712-3766
Mailing address:
  • Phone: 830-768-1818
  • Fax: 830-778-8618

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number0082282
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: KENNETH EDWARD WIESE
Title or Position: GENERAL MANAGER
Credential:
Phone: 830-775-4060