Healthcare Provider Details

I. General information

NPI: 1720034275
Provider Name (Legal Business Name): MAXWELL MEDICAL SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 03/09/2022
Certification Date: 03/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

506 E RAMSEY RD SUITE 1
SAN ANTONIO TX
78216-4657
US

IV. Provider business mailing address

506 E RAMSEY RD STE 1
SAN ANTONIO TX
78216-4657
US

V. Phone/Fax

Practice location:
  • Phone: 210-340-2217
  • Fax: 210-855-7884
Mailing address:
  • Phone: 210-340-2217
  • Fax: 210-855-7884

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number0040222
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number0040222
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number0040222
License Number StateTX

VIII. Authorized Official

Name: MR. LANDON GROFF
Title or Position: ADMINISTRATOR
Credential:
Phone: 210-340-2217