Provider Demographics
NPI:1093744161
Name:HACIENDA DME LLC
Entity Type:Organization
Organization Name:HACIENDA DME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GREGORIO
Authorized Official - Middle Name:
Authorized Official - Last Name:GARZA GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-688-8212
Mailing Address - Street 1:2408 BUDDY OWENS AVE
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-5463
Mailing Address - Country:US
Mailing Address - Phone:956-688-8212
Mailing Address - Fax:956-467-5589
Practice Address - Street 1:2408 BUDDY OWENS AVE
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-5463
Practice Address - Country:US
Practice Address - Phone:956-688-8212
Practice Address - Fax:956-467-5589
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-01
Last Update Date:2011-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0083512332B00000X, 332BP3500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX178212001Medicaid
TX178212002Medicaid
TX178212001Medicaid