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General NPI Number Information
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NPI Number | 1104153469
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Entity Type | Organization
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Legal Business Name | SAN ANTONIO MEDICAL SUPPLIES & HOME MODIFICATIONS
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Dates
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Enumeration Date | 11/06/2009
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Last Update Date | 06/28/2012
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Provider Practice Location Address
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Address Line | 1500 FREDERICKSBURG RD STE B
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City | SAN ANTONIO
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State | TX
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Zip | 78201-5029
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Country | US
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Telephone | 210-737-7269
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Fax | 210-737-7262
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Provider Business Mailing Address
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Address Line | 1500 FREDERICKSBURG RD STE B
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City | SAN ANTONIO
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State | TX
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Zip | 78201-5029
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Country | US
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Telephone | 210-737-7269
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Fax | 210-737-7262
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Authorized Official
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Title or Position | OWNER
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Name | MS. DONNA REYNA
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Credential |
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Telephone | 210-737-7269
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 0108615
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License Number State | TX
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