Provider Demographics
NPI:1134132558
Name:FREDERICKSBURG MEDICAL EQUIPMENT INC
Entity Type:Organization
Organization Name:FREDERICKSBURG MEDICAL EQUIPMENT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:V PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:CORNEHL
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:830-990-4775
Mailing Address - Street 1:1425 EAST MAIN STREET
Mailing Address - Street 2:SUITE 100
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78624-5330
Mailing Address - Country:US
Mailing Address - Phone:830-990-4775
Mailing Address - Fax:830-990-7597
Practice Address - Street 1:1425 EAST MAIN STREET
Practice Address - Street 2:SUITE 100
Practice Address - City:FREDERICKSBURG
Practice Address - State:TX
Practice Address - Zip Code:78624-5330
Practice Address - Country:US
Practice Address - Phone:830-990-4775
Practice Address - Fax:830-990-7597
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-15
Last Update Date:2014-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0052544332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX145960401Medicaid
TX531130OtherBCBS
TX5211530001Medicare ID - Type Unspecified