Provider Demographics
NPI:1568485456
Name:GULF BIOMECHANICAL LABORATORY LLC
Entity Type:Organization
Organization Name:GULF BIOMECHANICAL LABORATORY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:E
Authorized Official - Last Name:MYERS
Authorized Official - Suffix:
Authorized Official - Credentials:LPO
Authorized Official - Phone:210-495-3399
Mailing Address - Street 1:4045 E SOUTHCROSS BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78222-3636
Mailing Address - Country:US
Mailing Address - Phone:210-495-3999
Mailing Address - Fax:210-495-3393
Practice Address - Street 1:6801 MCPHERSON RD
Practice Address - Street 2:SUITE 222
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-6402
Practice Address - Country:US
Practice Address - Phone:956-722-6487
Practice Address - Fax:956-722-6366
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-25
Last Update Date:2019-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
TX101167335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX531343OtherBLUE CROSS O&P
TX091646205Medicaid
TX969599742OtherBLUE LINE
TX091646204Medicaid
TX091646204Medicaid