Provider Demographics
NPI:1659546943
Name:ANGELS MEDICAL SUPPLY CO
Entity Type:Organization
Organization Name:ANGELS MEDICAL SUPPLY CO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:CRUZ
Authorized Official - Middle Name:
Authorized Official - Last Name:MOLINA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:915-613-8558
Mailing Address - Street 1:13899 HORIZON BLVD
Mailing Address - Street 2:ST 3
Mailing Address - City:HORIZON CITY
Mailing Address - State:TX
Mailing Address - Zip Code:79928-6531
Mailing Address - Country:US
Mailing Address - Phone:915-613-8558
Mailing Address - Fax:915-852-6309
Practice Address - Street 1:13899 HORIZON BLVD
Practice Address - Street 2:ST 3
Practice Address - City:HORIZON CITY
Practice Address - State:TX
Practice Address - Zip Code:79928-6531
Practice Address - Country:US
Practice Address - Phone:915-613-8558
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-28
Last Update Date:2009-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX6129920001Medicare NSC