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General NPI Number Information
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NPI Number | 1013074046
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Entity Type | Organization
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Legal Business Name | MEDIKU FASTU LP
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Dates
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Enumeration Date | 01/02/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3241 N 38TH ST
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City | MCALLEN
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State | TX
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Zip | 78501-3301
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Country | US
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Telephone | 956-688-6334
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 6364
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City | MCALLEN
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State | TX
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Zip | 78502-6364
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Country | US
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Telephone | 956-688-6334
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Fax |
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Authorized Official
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Title or Position | PARTNER
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Name | MR. ERIC LUEBANOS
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Credential |
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Telephone | 956-688-6334
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BX2000X
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Taxonomy Name | Oxygen Equipment & Supplies (DME)
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License Number |
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License Number State |
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