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General NPI Number Information
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NPI Number | 1316078199
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Entity Type | Organization
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Legal Business Name | PROFESSIONAL MEDICAL SUPPLIES,DME, LLC
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Dates
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Enumeration Date | 03/07/2007
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Last Update Date | 06/22/2015
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Provider Practice Location Address
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Address Line | 119 W COMMERCIAL AVE
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City | LA FERIA
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State | TX
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Zip | 78559-5108
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Country | US
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Telephone | 956-277-0275
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Fax | 956-277-0269
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Provider Business Mailing Address
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Address Line | 119 W COMMERCIAL AVE
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City | LA FERIA
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State | TX
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Zip | 78559-5108
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Country | US
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Telephone | 956-277-0275
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Fax | 956-277-0269
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. SANDRA L OLIVAREZ
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Credential | PART OWNER
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Telephone | 956-277-0275
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BP3500X
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Taxonomy Name | Parenteral & Enteral Nutrition Supplies (DME)
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License Number | 0079427
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 0079427
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License Number State | TX
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