=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760628473
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AZTECA DURABLE MEDICAL EQUIPMENT
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/30/2008
-----------------------------------------------------
Last Update Date | 03/17/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 717 W. 2ND. ST.
-----------------------------------------------------
City | MERCEDES
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78570-2605
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-565-2000
-----------------------------------------------------
Fax | 956-565-2019
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 717 W 2ND ST
-----------------------------------------------------
City | MERCEDES
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78570-2605
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-565-2000
-----------------------------------------------------
Fax | 956-565-2019
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | MR. SEVERIANO ORTIZ
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 956-565-2000
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------