# FAYETTE MEDICAL SUPPLY, INC.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1295790061
- **Authorized official:** JONATHAN HERNANDEZ (OPERATIONS MANAGER)
- **Authorized official phone:** (979) 968-6680

## Contact information

- **Practice address:** 362 E TRAVIS ST, LA GRANGE, TX 78945-2619
- **Practice address phone:** (979) 968-6680
- **Practice address fax:** (979) 404-6082
- **Mailing address:** PO BOX 939, LA GRANGE, TX 78945-0939
- **Mailing address phone:** (979) 968-6680
- **Mailing address fax:** (979) 859-7184

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225CA2500X | Assistive Technology Supplier Rehabilitation Counselor | — | NULL | — |
| 225CA2500X | Assistive Technology Supplier Rehabilitation Counselor | — | — | — |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | — |
| 332BX2000X | Oxygen Equipment & Supplies (DME) | 0031424 | TX | Yes |

## Other

- **Enumeration date:** 04/17/2006
- **Last updated:** 10/02/2025