Organization
EAGLE PASS HOME MEDICAL SUPPLY 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
2822 N VETERANS BLVD STE C, EAGLE PASS, TX 78852-4819
(830) 773-0171
(830) 757-0789
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)
0082296
TX
332BX2000X
Oxygen Equipment & Supplies (DME)
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
175884901
—
TX
05
—
175884902
—
TX
01
—
507642
INSURANCE PROVIDER ID
TX
Enumeration date
11/14/2005
Last updated
10/20/2009
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Contact us