Provider Demographics
NPI:1457490476
Name:SANCO PAK, INC
Entity Type:Organization
Organization Name:SANCO PAK, INC
Other - Org Name:SANCO MEDICAL SUPPLY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:OKEY
Authorized Official - Middle Name:
Authorized Official - Last Name:OKOYE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-706-9228
Mailing Address - Street 1:5409 BANDERA RD STE 205B
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78238-1956
Mailing Address - Country:US
Mailing Address - Phone:210-706-9228
Mailing Address - Fax:210-342-5030
Practice Address - Street 1:BANDERA ROAD #205B
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78238
Practice Address - Country:US
Practice Address - Phone:210-706-9228
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2008-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0069920332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX4898190002Medicare NSC