Healthcare Provider Details

I. General information

NPI: 1215113238
Provider Name (Legal Business Name): ALL VALLEY MEDICAL SUPPLY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2008
Last Update Date: 07/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 E EXPRESSWAY 83 STE L2
PHARR TX
78577-6507
US

IV. Provider business mailing address

200 E EXPRESSWAY 83 STE L2
PHARR TX
78577-6507
US

V. Phone/Fax

Practice location:
  • Phone: 956-781-5800
  • Fax: 956-781-5873
Mailing address:
  • Phone: 956-781-5800
  • Fax: 956-781-5873

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number0079939
License Number StateTX

VIII. Authorized Official

Name: MR. KENNETH M FLORES
Title or Position: OWNER
Credential:
Phone: 956-781-5800