Provider Demographics
NPI:1164827978
Name:TEXAS DURABLE MEDICAL EQUIPMENT, INC
Entity Type:Organization
Organization Name:TEXAS DURABLE MEDICAL EQUIPMENT, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANTONIO
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVILA
Authorized Official - Suffix:
Authorized Official - Credentials:RN, CPED
Authorized Official - Phone:210-462-6211
Mailing Address - Street 1:PO BOX 830526
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78283-0526
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5235 SOUTHMOST RD
Practice Address - Street 2:SUITE D
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78521-8052
Practice Address - Country:US
Practice Address - Phone:956-525-4616
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TEXAS DURABLE MEDICAL EQUIPMENT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-10-23
Last Update Date:2014-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXCPED1199332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies