Provider Demographics
NPI:1659339612
Name:SAN ANGELO HEALTHCARE, INC
Entity Type:Organization
Organization Name:SAN ANGELO HEALTHCARE, INC
Other - Org Name:PROFESSIONAL MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BOB
Authorized Official - Middle Name:
Authorized Official - Last Name:GEORGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:325-653-1077
Mailing Address - Street 1:PO BOX 422
Mailing Address - Street 2:
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76902-0422
Mailing Address - Country:US
Mailing Address - Phone:325-653-1077
Mailing Address - Fax:325-658-7035
Practice Address - Street 1:4102 BUFFALO GAP RD STE J
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79605-7243
Practice Address - Country:US
Practice Address - Phone:325-672-1585
Practice Address - Fax:325-672-1475
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-01
Last Update Date:2008-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX503791OtherBLUE CROSS/ BLUE SHIELD
TX143518201, 143518202Medicaid
TX1310940002Medicare ID - Type Unspecified