MEDICARE: DISTRICT EMERGENCY MEDICAL SUPPLIES

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	0094180	TX

General Provider Information

NPI Number	:	1770753030
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DISTRICT EMERGENCY MEDICAL SUPPLIES

Provider Business Mailing Address
First Line	:	200 E EXPY 83 STE M
Second Line	:
City	:	PHARR
State	:	TX
Zip	:	78577-6506
Country	:	US
Telephone Number	:	956-787-3795
Fax Number	:	956-787-3796

Provider Business Practice Location Address
First Line	:	200 E EXPY 83 STE M
Second Line	:
City	:	PHARR
State	:	TX
Zip	:	78577-6506
Country	:	US
Telephone Number	:	956-787-3795
Fax Number	:	956-787-3796

Authorized Official
Title or Position	:	OWNER
Name	:	MR. JESUS EDWARDO CORPUS
Credential	:	PARAMEDIC
Telephone Number	:	956-787-3795

Provider Enumeration Date	:	03/03/2008
Last Update Date	:	03/03/2008

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