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General NPI Number Information
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NPI Number | 1275632291
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Entity Type | Organization
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Legal Business Name | MODERN MEDICAL EQUIPMENT
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Dates
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Enumeration Date | 09/22/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 5140 N 10TH ST SUITE B
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City | MCCALLEN
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State | TX
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Zip | 78504
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Country | US
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Telephone | 956-631-6918
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Fax | 956-631-6919
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Provider Business Mailing Address
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Address Line | PO BOX 6582
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City | MCCALLEN
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State | TX
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Zip | 78502
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Country | US
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Telephone | 956-631-6918
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Fax | 956-631-6919
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Authorized Official
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Title or Position | OWNER
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Name | MR. GARY GUILLERMO MOLINA SR.
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Credential | BSE AAS
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Telephone | 956-631-6918
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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 | 0067960
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License Number State | TX
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