Provider Demographics
NPI:1326023763
Name:EL PANCIERA INC
Entity Type:Organization
Organization Name:EL PANCIERA INC
Other - Org Name:BOCA CHICA MEDICAL SUPPLY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:EMIL
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:PANCIERA
Authorized Official - Suffix:
Authorized Official - Credentials:RRT
Authorized Official - Phone:956-542-4375
Mailing Address - Street 1:17 BOCA CHICA BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78520-7813
Mailing Address - Country:US
Mailing Address - Phone:956-542-4375
Mailing Address - Fax:956-542-4056
Practice Address - Street 1:17 BOCA CHICA BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78520-7813
Practice Address - Country:US
Practice Address - Phone:956-542-4375
Practice Address - Fax:956-542-4056
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-08
Last Update Date:2012-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0065168332B00000X, 332BP3500X
TX56083332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX177128901Medicaid
TX177128902Medicaid
TX177128901Medicaid