Provider Demographics
NPI:1275632291
Name:MODERN MEDICAL EQUIPMENT
Entity Type:Organization
Organization Name:MODERN MEDICAL EQUIPMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:GUILLERMO
Authorized Official - Last Name:MOLINA
Authorized Official - Suffix:SR
Authorized Official - Credentials:BSE AAS
Authorized Official - Phone:956-631-6918
Mailing Address - Street 1:PO BOX 6582
Mailing Address - Street 2:
Mailing Address - City:MCCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78502
Mailing Address - Country:US
Mailing Address - Phone:956-631-6918
Mailing Address - Fax:956-631-6919
Practice Address - Street 1:5140 N 10TH ST
Practice Address - Street 2:SUITE B
Practice Address - City:MCCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504
Practice Address - Country:US
Practice Address - Phone:956-631-6918
Practice Address - Fax:956-631-6919
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0067960332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies