Organization
DEL RIO HOME OXYGEN 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
1308 N BEDELL AVE, DEL RIO, TX 78840-7818
(830) 768-1818
(830) 778-8618
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
—
—
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
0082294
TX
332BX2000X
Oxygen Equipment & Supplies (DME)
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
176079501
—
TX
05
—
176079502
—
TX
01
—
507642
INSURANCE PROVIDER ID
TX
01
—
530697
BCBS PROVIDER ID
TX
Enumeration date
11/14/2005
Last updated
08/20/2008
Update your record
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