=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659633873
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SAN ANTONIO MEDICAL SUPPLIES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/13/2012
-----------------------------------------------------
Last Update Date | 04/19/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1800 NE LOOP 410
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78217-5213
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-737-7267
-----------------------------------------------------
Fax | 210-737-7262
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 100456
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78201-1756
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-737-7267
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | M.S. - LPC-S
-----------------------------------------------------
Name | MRS. ANDREA L ZUFLACHT-CUKJATI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 210-737-7267
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number | 1000945
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------