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Organization
FAYETTE MEDICAL SUPPLY, INC.
Active
Organization
FAYETTE MEDICAL SUPPLY, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JONATHAN HERNANDEZ (OPERATIONS MANAGER)
(979) 968-6680
Entity
Organization
Contact information
Practice address
123 OLD AUSTIN HWY, BASTROP, TX 78602-5128
(512) 332-0822
(512) 332-0020
Mailing address
PO BOX 1302, BASTROP, TX 78602-1302
(512) 332-0822
(512) 332-0020
Taxonomy
Speciality
Code
Description
License number
State
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)
Primary
0040642
TX
Other
Enumeration date
04/19/2006
Last updated
10/02/2025
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