Provider Demographics
NPI:1073522686
Name:ENVISION HOME MEDICAL EQUIPMENT
Entity Type:Organization
Organization Name:ENVISION HOME MEDICAL EQUIPMENT
Other - Org Name:JJ MEDICAL SUPPLY
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CARMONA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:915-313-3600
Mailing Address - Street 1:1812 MONTANA AVE
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-5720
Mailing Address - Country:US
Mailing Address - Phone:915-313-3600
Mailing Address - Fax:915-313-0475
Practice Address - Street 1:1812 MONTANA AVE
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-5720
Practice Address - Country:US
Practice Address - Phone:915-313-3600
Practice Address - Fax:915-313-0475
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUN CITY ENVISION HEALTHCARE SERVICES INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-05
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0078258332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
5314550001Medicare NSC