Organization
PROFESSIONAL MEDICAL SUPPLIES,DME, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SANDRA L OLIVAREZ PART OWNER (ADMINISTRATOR)
(956) 277-0275
Entity
Organization
Contact information
Practice address
119 W COMMERCIAL AVE, LA FERIA, TX 78559-5108
(956) 277-0275
(956) 277-0269
Mailing address
119 W COMMERCIAL AVE, LA FERIA, TX 78559-5108
(956) 277-0275
(956) 277-0269
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
0079427
TX
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
0079427
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
191498801
MEDICAID CROSSOVER
TX
05
—
191498802
—
TX
01
—
191498803
MEDICAID TEXAS HEALTH STEPS
TX
Enumeration date
03/07/2007
Last updated
06/22/2015
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