Provider Demographics
NPI:1235462508
Name:JACOB'S DME, LLC
Entity Type:Organization
Organization Name:JACOB'S DME, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANA
Authorized Official - Middle Name:M
Authorized Official - Last Name:DE LA CRUZ-RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-225-4728
Mailing Address - Street 1:7309 S CAGE BLVD
Mailing Address - Street 2:STE. D
Mailing Address - City:PHARR
Mailing Address - State:TX
Mailing Address - Zip Code:78577-9842
Mailing Address - Country:US
Mailing Address - Phone:956-787-5351
Mailing Address - Fax:956-787-5352
Practice Address - Street 1:7309 S CAGE BLVD
Practice Address - Street 2:STE. D
Practice Address - City:PHARR
Practice Address - State:TX
Practice Address - Zip Code:78577-9842
Practice Address - Country:US
Practice Address - Phone:956-787-5351
Practice Address - Fax:956-787-5352
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-17
Last Update Date:2010-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX6351400001Medicare NSC