Provider Demographics
NPI: | 1063665495 |
---|---|
Name: | BENJAMINO L GRANATO |
Entity Type: | Organization |
Organization Name: | BENJAMINO L GRANATO |
Other - Org Name: | ALPHA DIABETIC SUPPLY |
Other - Org Type: | Former Legal Business Name |
Authorized Official - Title/Position: | OWNER |
Authorized Official - Prefix: | MR |
Authorized Official - First Name: | BENJAMINO |
Authorized Official - Middle Name: | L |
Authorized Official - Last Name: | GRANATO |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 210-521-5884 |
Mailing Address - Street 1: | P.O. BOX 761801 |
Mailing Address - Street 2: | |
Mailing Address - City: | SAN ANTONIO |
Mailing Address - State: | TX |
Mailing Address - Zip Code: | 78245 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 210-521-5884 |
Mailing Address - Fax: | 210-521-0074 |
Practice Address - Street 1: | 6415 BANDERA |
Practice Address - Street 2: | |
Practice Address - City: | SAN ANTONIO |
Practice Address - State: | TX |
Practice Address - Zip Code: | 78238 |
Practice Address - Country: | US |
Practice Address - Phone: | 210-785-9959 |
Practice Address - Fax: | 210-785-9868 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2008-10-29 |
Last Update Date: | 2008-10-29 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
TX | 332B00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 332B00000X | Suppliers | Durable Medical Equipment & Medical Supplies |