Healthcare Provider Details

I. General information

NPI: 1245416478
Provider Name (Legal Business Name): VALLEY MEDICAL SUPPLY LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2008
Last Update Date: 12/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 E EXPRESSWAY 83 SUITE P
PHARR TX
78577-6507
US

IV. Provider business mailing address

200 E EXPRESSWAY 83 SUITE P
PHARR TX
78577-6507
US

V. Phone/Fax

Practice location:
  • Phone: 956-702-1100
  • Fax: 956-702-1104
Mailing address:
  • Phone: 956-702-1100
  • Fax: 956-702-1104

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. RAMIRO MARTINEZ
Title or Position: MANGER
Credential:
Phone: 956-630-5999