=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245338268
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AZTECA DME
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/21/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2919 E. PIKE BLVD.
-----------------------------------------------------
City | WESLACO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78596
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-969-3401
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3516 E. EXPWY 83 SUITE 101
-----------------------------------------------------
City | WESLACO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78596
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-968-5420
-----------------------------------------------------
Fax | 956-968-8146
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. GERMAN SALCE III
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 956-968-5420
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332BX2000X
-----------------------------------------------------
Taxonomy Name | Oxygen Equipment & Supplies (DME)
-----------------------------------------------------
License Number | 0087272
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------