Organization
AMERICAN 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
5918 MCPHERSON RD STE 4, LAREDO, TX 78041-6159
(956) 712-2273
(956) 712-3766
Mailing address
1011 E 7TH ST, DEL RIO, TX 78840-4162
(830) 768-1818
(830) 778-8618
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
0082282
TX
332BX2000X
Oxygen Equipment & Supplies (DME)
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
177619701
—
TX
05
—
177619702
—
TX
05
—
177619703
—
TX
05
—
177619704
—
TX
01
—
507642
INSURANCE PROVIDER ID
TX
Enumeration date
02/10/2006
Last updated
08/20/2008
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