MEDICARE: ANGELIC MEDICAL DESIGNS 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	332B00000X	Durable Medical Equipment & Medical Supplies	1001404	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	:	1427468099
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANGELIC MEDICAL DESIGNS LLC

Provider Business Mailing Address
First Line	:	7043 BANDERA RD
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78238-1266
Country	:	US
Telephone Number	:	210-384-9201
Fax Number	:	201-384-9212

Provider Business Practice Location Address
First Line	:	7043 BANDERA RD
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78238-1266
Country	:	US
Telephone Number	:	210-384-9201
Fax Number	:	201-384-9212

Authorized Official
Title or Position	:	OWNER/ PRESIDENT
Name	:	MRS. MARY J RIOS
Credential	:	LVN
Telephone Number	:	210-414-9014

Provider Enumeration Date	:	05/05/2014
Last Update Date	:	06/24/2015

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Directions to “ANGELIC MEDICAL DESIGNS LLC ” Practice Location

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