Healthcare Provider Details

I. General information

NPI: 1508802448
Provider Name (Legal Business Name): SMILE MEDICAL EQUIPMENT & SUPPLIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5088B W HIGHWAY 83
ROMA TX
78584-6602
US

IV. Provider business mailing address

6547 FM 1430 APT. 28
RIO GRANDE TX
78582-9336
US

V. Phone/Fax

Practice location:
  • Phone: 956-849-9049
  • Fax: 956-849-9049
Mailing address:
  • Phone: 956-849-9049
  • Fax: 956-849-9049

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number0089440
License Number StateTX

VIII. Authorized Official

Name: MR. OVANDO ANDRES BARRERA
Title or Position: CO OWNER
Credential:
Phone: 956-844-2893