Healthcare Provider Details

I. General information

NPI: 1043417827
Provider Name (Legal Business Name): WINTERGARDEN MOBILITY REPAIR &SUPPLIES,INCOR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2007
Last Update Date: 01/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1739 BIH 35 EAST
PEARSALL TX
78061-2804
US

IV. Provider business mailing address

1739 BIH 35 EAST
PEARSALL TX
78061-2804
US

V. Phone/Fax

Practice location:
  • Phone: 830-334-8748
  • Fax: 830-334-3135
Mailing address:
  • Phone: 830-334-8748
  • Fax: 830-334-3135

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MR. JAIME N HERNANDEZ
Title or Position: PRESIDENT
Credential:
Phone: 830-334-8748