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Organization
EAGLE PASS HOME MEDICAL SUPPLY LLC
Active
Organization
EAGLE PASS HOME MEDICAL SUPPLY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KENNETH EDWARD WIESE (GENERAL MANAGER)
(830) 775-4060
Entity
Organization
Contact information
Practice address
2822 N VETERANS BLVD STE C, EAGLE PASS, TX 78852-4819
(830) 773-0171
(830) 757-0789
Mailing address
1011 E 7TH ST, DEL RIO, TX 78840-4162
(830) 775-4060
(830) 775-4038
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
NULL
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
0082296
TX
332BX2000X
Oxygen Equipment & Supplies (DME)
—
NULL
Other
Enumeration date
11/14/2005
Last updated
10/20/2009
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