Provider Demographics
NPI:1134300692
Name:PL MEDICAL SUPPLY, INC.
Entity Type:Organization
Organization Name:PL MEDICAL SUPPLY, INC.
Other - Org Name:PRODUCTIVE LIFE MEDICAL SUPPLY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:NOEMI
Authorized Official - Middle Name:
Authorized Official - Last Name:VILLARREAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:915-858-8552
Mailing Address - Street 1:2034 E GRIFFIN PKWY
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78572-3223
Mailing Address - Country:US
Mailing Address - Phone:956-580-7577
Mailing Address - Fax:956-580-9073
Practice Address - Street 1:2034 E GRIFFIN PKWY
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-3223
Practice Address - Country:US
Practice Address - Phone:956-580-7577
Practice Address - Fax:956-580-9073
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-26
Last Update Date:2008-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0100872332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX147473601Medicaid
TX4312430001Medicare NSC