Organization
PRIMARY HEALTH SOURCE INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOEL HERNANDEZ JR. (PRESIDENT)
(956) 753-0438
Entity
Organization
Contact information
Practice address
1517 LINCOLN ST, LAREDO, TX 78040-5712
(956) 753-0438
(956) 712-9146
Mailing address
1517 LINCOLN ST, LAREDO, TX 78040-5712
(956) 753-0438
(956) 712-9146
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
0080659
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
181320602
—
TX
Enumeration date
05/09/2006
Last updated
03/12/2010
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