MEDICARE: HOME-BOUND-MED LLC

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	363LP2300X	Primary Care Nurse Practitioner

General Provider Information

NPI Number	:	1255197273
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOME-BOUND-MED LLC

Provider Business Mailing Address
First Line	:	6090 SURETY DR STE 420
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79905-2057
Country	:	US
Telephone Number	:	915-303-9215
Fax Number	:	915-218-6518

Provider Business Practice Location Address
First Line	:	1701 BASSETT AVE STE 115
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79901-1801
Country	:	US
Telephone Number	:	915-799-1782
Fax Number	:	915-205-6909

Authorized Official
Title or Position	:	DIRECTOR
Name	:	JOANNA PENA
Credential	:
Telephone Number	:	915-799-1782

Provider Enumeration Date	:	02/27/2024
Last Update Date	:	04/16/2024

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