=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104071604
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | I.G. CONSULTING SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/25/2008
-----------------------------------------------------
Last Update Date | 11/25/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11424 RANDY PETRI LN
-----------------------------------------------------
City | EL PASO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79936-4714
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 915-307-5755
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11424 RANDY PETRI LN
-----------------------------------------------------
City | EL PASO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79936-4714
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 915-307-5755
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT & CEO
-----------------------------------------------------
Name | MRS. IRMA O GUTIERREZ
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 915-307-5766
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------