# EAGLE PASS HOME MEDICAL SUPPLY LLC

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

## Provider details

- **NPI number:** 1588646863
- **Authorized official:** KENNETH EDWARD WIESE (GENERAL MANAGER)
- **Authorized official phone:** (830) 775-4060

## Contact information

- **Practice address:** 2822 N VETERANS BLVD STE C, EAGLE PASS, TX 78852-4819
- **Practice address phone:** (830) 773-0171
- **Practice address fax:** (830) 757-0789
- **Mailing address:** 1011 E 7TH ST, DEL RIO, TX 78840-4162
- **Mailing address phone:** (830) 775-4060
- **Mailing address fax:** (830) 775-4038

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | Yes |
| 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