Provider Demographics
NPI:1447218516
Name:SAN ANGELO HEALTHCARE, INC.
Entity Type:Organization
Organization Name:SAN ANGELO HEALTHCARE, INC.
Other - Org Name:PROFESSIONAL MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BOB
Authorized Official - Middle Name:
Authorized Official - Last Name:GEORGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:325-653-1077
Mailing Address - Street 1:PO BOX 422
Mailing Address - Street 2:
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76902-0422
Mailing Address - Country:US
Mailing Address - Phone:325-653-1077
Mailing Address - Fax:325-658-7035
Practice Address - Street 1:1313 S 1ST ST
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76504-5762
Practice Address - Country:US
Practice Address - Phone:254-773-4309
Practice Address - Fax:254-773-4932
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX143522401, 143523201Medicaid
TX143522401, 143523201Medicaid