MEDICARE: ELEAZAR RANGEL RRTS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332BC3200X	Customized Equipment (DME)	1009261	CO
2	247200000X	Other Technician	1009261	CO

General Provider Information

NPI Number	:	1104105089
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELEAZAR RANGEL RRTS

Provider Business Mailing Address
First Line	:	6400 AIRPORT RD STE H
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79925-1049
Country	:	US
Telephone Number	:	915-532-4555
Fax Number	:	915-562-7609

Provider Business Practice Location Address
First Line	:	6400 AIRPORT RD STE H
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79925-1049
Country	:	US
Telephone Number	:	915-532-4555
Fax Number	:	915-562-7609

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/10/2011
Last Update Date	:	08/29/2011

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