Provider Demographics
NPI:1164506481
Name:VALLEY MEDICAL FOOTWEAR LLC
Entity Type:Organization
Organization Name:VALLEY MEDICAL FOOTWEAR LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:
Authorized Official - Last Name:ESCOBEDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-664-0655
Mailing Address - Street 1:4400 N MCCOLL RD
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-2480
Mailing Address - Country:US
Mailing Address - Phone:956-664-0655
Mailing Address - Fax:956-664-0774
Practice Address - Street 1:4400 N MCCOLL RD
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-2480
Practice Address - Country:US
Practice Address - Phone:956-664-0655
Practice Address - Fax:956-664-0774
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2012-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX010919101Medicaid
TX016826201Medicaid
TX6489190001Medicare NSC