MEDICARE: ALAMO FIESTA MEDICAL SUPPLY

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	332B00000X	Durable Medical Equipment & Medical Supplies	0076352	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1144360348
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALAMO FIESTA MEDICAL SUPPLY

Provider Business Mailing Address
First Line	:	BOX 3716
Second Line	:
City	:	ALAMO
State	:	TX
Zip	:	78516
Country	:	US
Telephone Number	:	956-702-1848
Fax Number	:	956-702-1852

Provider Business Practice Location Address
First Line	:	1040 WEST ELLIS
Second Line	:
City	:	ALAMO
State	:	TX
Zip	:	78516-2593
Country	:	US
Telephone Number	:	956-702-1848
Fax Number	:	956-702-1852

Authorized Official
Title or Position	:	OWNER
Name	:	JULIETA QUIRINO
Credential	:
Telephone Number	:	956-702-2167

Provider Enumeration Date	:	02/07/2007
Last Update Date	:	06/27/2011

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Directions to “ALAMO FIESTA MEDICAL SUPPLY ” Practice Location

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