MEDICARE: SONOVEX MEDICAL SOLUTIONS, 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

General Provider Information

NPI Number	:	1649654245
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SONOVEX MEDICAL SOLUTIONS, LLC

Provider Business Mailing Address
First Line	:	19179 BLANCO RD
Second Line	:	SUITE 105 / UNIT 482
City	:	SAN ANTONIO
State	:	TX
Zip	:	78258-4042
Country	:	US
Telephone Number	:	844-766-6839
Fax Number	:

Provider Business Practice Location Address
First Line	:	19179 BLANCO RD
Second Line	:	SUITE 105 / UNIT 482
City	:	SAN ANTONIO
State	:	TX
Zip	:	78258-4042
Country	:	US
Telephone Number	:	844-766-6839
Fax Number	:

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. CARL J BONNETT
Credential	:	M.D.
Telephone Number	:	303-945-6054

Provider Enumeration Date	:	07/13/2015
Last Update Date	:	07/20/2015

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