Provider Demographics
NPI:1346507514
Name:MEDICAL MART & DME
Entity Type:Organization
Organization Name:MEDICAL MART & DME
Other - Org Name:HEALTH PLUS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PIC
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:FAT-ANTHONY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-424-3535
Mailing Address - Street 1:3401 W MILE 5 RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78574-5313
Mailing Address - Country:US
Mailing Address - Phone:956-424-3535
Mailing Address - Fax:956-424-3599
Practice Address - Street 1:3401 W MILE 5 RD
Practice Address - Street 2:SUITE 2
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78574-5313
Practice Address - Country:US
Practice Address - Phone:956-424-3535
Practice Address - Fax:956-424-3599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-12
Last Update Date:2017-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 332BD1200X, 332BN1400X, 332BP3500X, 332BX2000X, 333600000X, 3336C0004X, 3336H0001X, 3336S0011X
TX282383336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BD1200XSuppliersDurable Medical Equipment & Medical SuppliesDialysis Equipment & Supplies
No332BN1400XSuppliersDurable Medical Equipment & Medical SuppliesNursing Facility Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2136913OtherPK
7457950001Medicare PIN