Provider Demographics
NPI:1295831089
Name:H&S CHAMPS MEDICAL, LTD
Entity Type:Organization
Organization Name:H&S CHAMPS MEDICAL, LTD
Other - Org Name:CHAMPS MEDICAL / SIMON AND SIMON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-614-1414
Mailing Address - Street 1:7718 LOUIS PASTEUR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229
Mailing Address - Country:US
Mailing Address - Phone:210-614-1414
Mailing Address - Fax:210-614-3078
Practice Address - Street 1:7718 LOUIS PASTEUR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229
Practice Address - Country:US
Practice Address - Phone:210-614-1414
Practice Address - Fax:210-614-3078
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-16
Last Update Date:2017-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0052940332B00000X
TX0046750332BC3200X, 332BP3500X, 332BX2000X
TX0052939332BX2000X
TX0046750 C332BX2000X
TX208683336C0003X
TX1000161332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2095857OtherPK
TX140609201Medicaid
TX140649801Medicaid
TX509252OtherBLUE CROSS BLUE SHIELD TX
TX142484802Medicaid
TX142484802Medicaid