Provider Demographics
NPI:1497895171
Name:MAXMED HEALTHCARE, INC
Entity Type:Organization
Organization Name:MAXMED HEALTHCARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:OLUSEGUN
Authorized Official - Middle Name:
Authorized Official - Last Name:OYEWOLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-979-7805
Mailing Address - Street 1:PO BOX 592240
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78259-0161
Mailing Address - Country:US
Mailing Address - Phone:210-599-3233
Mailing Address - Fax:210-579-6654
Practice Address - Street 1:506 E RAMSEY RD
Practice Address - Street 2:SUITE 1
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-4657
Practice Address - Country:US
Practice Address - Phone:210-599-3233
Practice Address - Fax:210-579-6654
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2012-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX008735251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX170427201Medicaid
TX453194Medicare Oscar/Certification