Provider Demographics
NPI:1639395023
Name:HACIENDA MEDICAL EQUIPMENT AND SUPPLIES
Entity Type:Organization
Organization Name:HACIENDA MEDICAL EQUIPMENT AND SUPPLIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:VINCENTE
Authorized Official - Middle Name:ALBERTO
Authorized Official - Last Name:GUTIERREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-687-2223
Mailing Address - Street 1:5500 N. MCCOLL RD.
Mailing Address - Street 2:BLDG D PMB#109
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-2242
Mailing Address - Country:US
Mailing Address - Phone:956-687-2223
Mailing Address - Fax:956-687-2230
Practice Address - Street 1:5520 N. MCCOLL RD
Practice Address - Street 2:STE 'I'
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-2242
Practice Address - Country:US
Practice Address - Phone:956-687-2223
Practice Address - Fax:956-687-2230
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2011-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0094109332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX5936150001Medicare NSC