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General NPI Number Information
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NPI Number | 1396755062
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Entity Type | Organization
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Legal Business Name | MEDALLION MEDICAL EQUIPMENT LLC
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Dates
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Enumeration Date | 08/08/2006
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Last Update Date | 07/17/2012
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Provider Practice Location Address
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Address Line | 105 PALMVIEW DR D
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City | PALMVIEW
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State | TX
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Zip | 78572-8778
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Country | US
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Telephone | 956-581-1508
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Fax | 956-581-1508
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Provider Business Mailing Address
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Address Line | 105 PALMVIEW DR D
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City | PALMVIEW
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State | TX
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Zip | 78572-8778
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Country | US
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Telephone | 956-581-1508
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Fax | 956-581-1508
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Authorized Official
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Title or Position | OWNER
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Name | ROBERTO CARLOS DOMINGUEZ
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Credential |
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Telephone | 956-581-1508
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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 | 0077673
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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 | 1000367
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License Number State | TX
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