Provider Demographics
NPI:1376659557
Name:LIFECARE REUSS PHARMACY LLC
Entity Type:Organization
Organization Name:LIFECARE REUSS PHARMACY LLC
Other - Org Name:REUSS MEDICAL EQUIPMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DME COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:J
Authorized Official - Last Name:ZENGERLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:361-275-3412
Mailing Address - Street 1:PO BOX 270
Mailing Address - Street 2:
Mailing Address - City:CUERO
Mailing Address - State:TX
Mailing Address - Zip Code:77954-0270
Mailing Address - Country:US
Mailing Address - Phone:361-275-3412
Mailing Address - Fax:361-275-6399
Practice Address - Street 1:515 N ESPLANADE ST
Practice Address - Street 2:
Practice Address - City:CUERO
Practice Address - State:TX
Practice Address - Zip Code:77954-3603
Practice Address - Country:US
Practice Address - Phone:361-275-3412
Practice Address - Fax:361-275-6399
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX30017332B00000X, 332BX2000X, 335G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335G00000XSuppliersMedical Foods Supplier
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX013912302Medicaid
7362040001Medicare NSC
TX108497201Medicaid
7362040001Medicare NSC
TX108497201Medicaid