Healthcare Provider Details

I. General information

NPI: 1912336611
Provider Name (Legal Business Name): ALAMO CITY DURABLE MEDICAL EQUIPMENT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2013
Last Update Date: 05/12/2020
Certification Date: 05/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10643 SENTINEL ST
SAN ANTONIO TX
78217-3811
US

IV. Provider business mailing address

10643 SENTINEL ST
SAN ANTONIO TX
78217-3811
US

V. Phone/Fax

Practice location:
  • Phone: 210-829-5900
  • Fax: 210-829-3760
Mailing address:
  • Phone: 210-829-5900
  • Fax: 210-829-3760

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 TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: PATRICIA LYNN HOLSTEAD
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 210-737-2444