Provider Demographics
NPI:1205027174
Name:ALBERT MAGALLAN JR
Entity Type:Organization
Organization Name:ALBERT MAGALLAN JR
Other - Org Name:AFFIRMED DME
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:MAGALLAN
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:956-687-7572
Mailing Address - Street 1:PO BOX 1137
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78505-1137
Mailing Address - Country:US
Mailing Address - Phone:956-687-7572
Mailing Address - Fax:956-687-2726
Practice Address - Street 1:1231 E HACKBERRY AVE
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78501-5736
Practice Address - Country:US
Practice Address - Phone:956-687-7572
Practice Address - Fax:956-687-2726
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-06
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXTXD0013644332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX185029903Medicaid
TX5811850001Medicare NSC