Organization
GULF BIOMECHANICAL LABORATORY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANTHONY E MYERS L.P.O. (OWNER)
(210) 495-3399
Entity
Organization
Contact information
Practice address
6801 MCPHERSON RD, SUITE 222, LAREDO, TX 78041-6402
(956) 722-6487
(956) 722-6366
Mailing address
4045 E SOUTHCROSS BLVD, SAN ANTONIO, TX 78222-3636
(210) 495-3999
(210) 495-3393
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
335E00000X
Prosthetic/Orthotic Supplier
Primary
101167
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
091646204
—
TX
05
—
091646205
—
TX
01
—
531343
BLUE CROSS O&P
TX
01
—
969599742
BLUE LINE
TX
Enumeration date
07/25/2006
Last updated
04/02/2019
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