Provider Demographics
NPI:1043312309
Name:MORIAH MEDICAL SUPPLIES LLC.
Entity Type:Organization
Organization Name:MORIAH MEDICAL SUPPLIES LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:IRMA
Authorized Official - Middle Name:
Authorized Official - Last Name:CANTU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-266-5456
Mailing Address - Street 1:4869 ELOY ST
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78521-5425
Mailing Address - Country:US
Mailing Address - Phone:956-831-0158
Mailing Address - Fax:956-831-0168
Practice Address - Street 1:2401 VILLAGE DR STE C
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78521-1410
Practice Address - Country:US
Practice Address - Phone:956-831-0158
Practice Address - Fax:956-982-3990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-05
Last Update Date:2009-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX5797860001Medicare NSC