Provider Demographics
NPI:1427384981
Name:PEDRO MEDRANO
Entity Type:Organization
Organization Name:PEDRO MEDRANO
Other - Org Name:GO DME MEDICAL EQUIPMENT & SUPPLY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/ ADDMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:PEDRO
Authorized Official - Middle Name:
Authorized Official - Last Name:MEDRANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-565-9438
Mailing Address - Street 1:909 IVY AVE
Mailing Address - Street 2:
Mailing Address - City:DONNA
Mailing Address - State:TX
Mailing Address - Zip Code:78537-3978
Mailing Address - Country:US
Mailing Address - Phone:956-355-1413
Mailing Address - Fax:
Practice Address - Street 1:50 N VERMONT AVE
Practice Address - Street 2:SUITE #A
Practice Address - City:MERCEDES
Practice Address - State:TX
Practice Address - Zip Code:78570-2519
Practice Address - Country:US
Practice Address - Phone:956-565-9438
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-19
Last Update Date:2013-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11420096429332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX281518502Medicaid
TX281518501Medicaid
TX281518502Medicaid