MEDICARE: H-E-B, LP

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	291U00000X	Clinical Medical Laboratory
2	3336C0003X	Community/Retail Pharmacy

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

General Provider Information

NPI Number	:	1669035333
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	H-E-B, LP

Provider Business Mailing Address
First Line	:	646 S FLORES ST
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78204-1219
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3663 WASHINGTON AVE SUITE 100
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77007
Country	:	US
Telephone Number	:	713-426-1961
Fax Number	:	832-673-3183

Authorized Official
Title or Position	:	GOVERNMENT PROGRAMS MANAGER
Name	:	DAVID LIENDO
Credential	:
Telephone Number	:	210-938-3182

Provider Enumeration Date	:	04/18/2019
Last Update Date	:	09/25/2020

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Directions to “H-E-B, LP ” Practice Location

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