Provider Demographics
NPI:1306025325
Name:MED-TRO EQUIPMENT AND MEDICAL SUPPLIES, LLC
Entity Type:Organization
Organization Name:MED-TRO EQUIPMENT AND MEDICAL SUPPLIES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:JOVITA
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-783-1110
Mailing Address - Street 1:909 W FM 495
Mailing Address - Street 2:SUITE 4
Mailing Address - City:SAN JUAN
Mailing Address - State:TX
Mailing Address - Zip Code:78589-3501
Mailing Address - Country:US
Mailing Address - Phone:956-783-1110
Mailing Address - Fax:956-783-1130
Practice Address - Street 1:909 W FM 495
Practice Address - Street 2:SUITE 4
Practice Address - City:SAN JUAN
Practice Address - State:TX
Practice Address - Zip Code:78589-3501
Practice Address - Country:US
Practice Address - Phone:956-783-1110
Practice Address - Fax:956-783-1130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-25
Last Update Date:2009-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX6084380001Medicare NSC