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General NPI Number Information
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NPI Number | 1538124953
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Entity Type | Organization
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Legal Business Name | FAYETTE MEDICAL SUPPLY, INC.
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Dates
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Enumeration Date | 04/19/2006
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Last Update Date | 10/02/2025
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Provider Practice Location Address
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Address Line | 123 OLD AUSTIN HWY
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City | BASTROP
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State | TX
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Zip | 78602-5128
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Country | US
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Telephone | 512-332-0822
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Fax | 512-332-0020
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Provider Business Mailing Address
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Address Line | PO BOX 1302
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City | BASTROP
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State | TX
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Zip | 78602-1302
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Country | US
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Telephone | 512-332-0822
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Fax | 512-332-0020
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Authorized Official
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Title or Position | OPERATIONS MANAGER
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Name | JONATHAN HERNANDEZ
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Credential |
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Telephone | 979-968-6680
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225CA2500X
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Taxonomy Name | Assistive Technology Supplier Rehabilitation Counselor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 332BX2000X
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Taxonomy Name | Oxygen Equipment & Supplies (DME)
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License Number | 0040642
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License Number State | TX
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