Provider Demographics
NPI:1609908425
Name:SERGIO TREVINO
Entity Type:Organization
Organization Name:SERGIO TREVINO
Other - Org Name:OMNI CARE MEDICAL SUPPLIES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:SERGIO
Authorized Official - Middle Name:
Authorized Official - Last Name:TREVINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-487-0233
Mailing Address - Street 1:400 E 2ND ST
Mailing Address - Street 2:STE B
Mailing Address - City:RIO GRANDE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:78582-3808
Mailing Address - Country:US
Mailing Address - Phone:956-487-0233
Mailing Address - Fax:956-487-4749
Practice Address - Street 1:400 E 2ND ST
Practice Address - Street 2:STE B
Practice Address - City:RIO GRANDE CITY
Practice Address - State:TX
Practice Address - Zip Code:78582-5633
Practice Address - Country:US
Practice Address - Phone:956-487-0233
Practice Address - Fax:956-487-4749
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-09
Last Update Date:2015-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0069667332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX173211701OtherCCP
TX173211702Medicaid
TX5308990001OtherMEDICARE
TX173211701Medicaid