Healthcare Provider Details

I. General information

NPI: 1770931693
Provider Name (Legal Business Name): MEDICOR HEALTHCARE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2016
Last Update Date: 06/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15555 TRADESMAN SUITE 100
SAN ANTONIO TX
78249-1322
US

IV. Provider business mailing address

15555 TRADESMAN SUITE 100
SAN ANTONIO TX
78249-1322
US

V. Phone/Fax

Practice location:
  • Phone: 800-250-4468
  • Fax: 866-930-8001
Mailing address:
  • Phone: 800-250-4468
  • Fax: 866-930-8001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number0081934
License Number StateTX

VIII. Authorized Official

Name: BRIAN CLAYTON MCPETERS
Title or Position: Q A MANAGER
Credential:
Phone: 813-930-8000