Provider Demographics
NPI:1073096418
Name:SAN AN DME LLC
Entity Type:Organization
Organization Name:SAN AN DME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:BLAKELEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-787-1656
Mailing Address - Street 1:PO BOX 734294
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75373-4294
Mailing Address - Country:US
Mailing Address - Phone:210-787-1656
Mailing Address - Fax:
Practice Address - Street 1:3201 CHERRY RIDGE ST STE B220
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78230-4842
Practice Address - Country:US
Practice Address - Phone:210-787-1656
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-12
Last Update Date:2019-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies