Healthcare Provider Details

I. General information

NPI: 1578614939
Provider Name (Legal Business Name): CHAMPION MEDICAL INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2007
Last Update Date: 07/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33840 S. GARCIA #20
PORT ISABEL TX
78578
US

IV. Provider business mailing address

33840 S. GARCIA #20
PORT ISABEL TX
78578
US

V. Phone/Fax

Practice location:
  • Phone: 832-640-7834
  • Fax: 866-222-0783
Mailing address:
  • Phone: 832-640-7834
  • Fax: 866-222-0783

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 Code261QH0100X
TaxonomyHealth Service Clinic/Center
License NumberDC2783
License Number StateTX

VIII. Authorized Official

Name: MRS. CAROLE J BAXTER
Title or Position: V.P.
Credential:
Phone: 832-640-7834