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General NPI Number Information
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NPI Number | 1679787899
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Entity Type | Organization
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Legal Business Name | MIRACLE MEDICAL EQUIPMENT AND SUPPLIES OF SOUTH TEXAS LLC
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Dates
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Enumeration Date | 05/09/2007
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Last Update Date | 07/25/2018
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Provider Practice Location Address
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Address Line | 1020 PALM PARKWAY DR
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City | WESLACO
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State | TX
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Zip | 78596
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Country | US
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Telephone | 956-969-9596
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Fax | 956-969-9569
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Provider Business Mailing Address
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Address Line | 1020 PALM PARKWAY DR
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City | WESLACO
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State | TX
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Zip | 78596-1203
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Country | US
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Telephone | 956-969-9596
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Fax | 956-969-9569
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Authorized Official
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Title or Position | CEO
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Name | JORGE LEE LOZANO
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Credential |
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Telephone | 956-969-9596
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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 | 0077132
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License Number State | TX
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