Organization
LONG TERM MEDICAL EQUIPMENT AND SUPPLIES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EMMANUEL IROANYA (OWNER)
(512) 374-9080
Entity
Organization
Contact information
Practice address
111 W ANDERSON LN, D 206, AUSTIN, TX 78752-1132
(512) 374-9080
(512) 374-0053
Mailing address
111 W ANDERSON LN, D 206, AUSTIN, TX 78752-1132
(512) 374-9080
(512) 374-0053
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
0070596
TX
332BX2000X
Oxygen Equipment & Supplies (DME)
Primary
0070596
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
168047201
—
TX
05
—
168047202
—
TX
01
—
531697
BLUE CROSS BLUE SHIELD
TX
Enumeration date
04/11/2006
Last updated
08/28/2009
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