Provider Demographics
NPI:1578614939
Name:CHAMPION MEDICAL INC.
Entity Type:Organization
Organization Name:CHAMPION MEDICAL INC.
Other - Org Name:STERLING IMAGING
Other - Org Type:Other Name
Authorized Official - Title/Position:V.P.
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROLE
Authorized Official - Middle Name:J
Authorized Official - Last Name:BAXTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-640-7834
Mailing Address - Street 1:33840 S. GARCIA
Mailing Address - Street 2:#20
Mailing Address - City:PORT ISABEL
Mailing Address - State:TX
Mailing Address - Zip Code:78578
Mailing Address - Country:US
Mailing Address - Phone:832-640-7834
Mailing Address - Fax:866-222-0783
Practice Address - Street 1:33840 S. GARCIA
Practice Address - Street 2:#20
Practice Address - City:PORT ISABEL
Practice Address - State:TX
Practice Address - Zip Code:78578
Practice Address - Country:US
Practice Address - Phone:832-640-7834
Practice Address - Fax:866-222-0783
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-14
Last Update Date:2009-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDC2783261QH0100X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies