Organization
MEDALLION MEDICAL EQUIPMENT LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERTO CARLOS DOMINGUEZ (OWNER)
(956) 581-1508
Entity
Organization
Contact information
Practice address
105 PALMVIEW DR, D, PALMVIEW, TX 78572-8778
(956) 581-1508
(956) 581-1508
Mailing address
105 PALMVIEW DR, D, PALMVIEW, TX 78572-8778
(956) 581-1508
(956) 581-1508
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
0077673
TX
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
1000367
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
169537101
—
TX
05
—
169537102
—
TX
Enumeration date
08/08/2006
Last updated
07/17/2012
Update your record
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