Provider Demographics
NPI:1043417827
Name:WINTERGARDEN MOBILITY REPAIR &SUPPLIES,INCOR
Entity Type:Organization
Organization Name:WINTERGARDEN MOBILITY REPAIR &SUPPLIES,INCOR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAIME
Authorized Official - Middle Name:N
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:830-334-8748
Mailing Address - Street 1:1739 BIH 35 EAST
Mailing Address - Street 2:
Mailing Address - City:PEARSALL
Mailing Address - State:TX
Mailing Address - Zip Code:78061-2804
Mailing Address - Country:US
Mailing Address - Phone:830-334-8748
Mailing Address - Fax:830-334-3135
Practice Address - Street 1:1739 BIH 35 EAST
Practice Address - Street 2:
Practice Address - City:PEARSALL
Practice Address - State:TX
Practice Address - Zip Code:78061-2804
Practice Address - Country:US
Practice Address - Phone:830-334-8748
Practice Address - Fax:830-334-3135
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-27
Last Update Date:2013-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX6169060001Medicare NSC