Provider Demographics
NPI:1710485875
Name:ONE HOME MEDICAL EQUIPMENT TX LLC
Entity Type:Organization
Organization Name:ONE HOME MEDICAL EQUIPMENT TX LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:ESTEVAN
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-792-0427
Mailing Address - Street 1:3351 EXECUTIVE WAY
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33025-3935
Mailing Address - Country:US
Mailing Address - Phone:954-417-6454
Mailing Address - Fax:855-441-6941
Practice Address - Street 1:8233 LEOPARD ST
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78409-2225
Practice Address - Country:US
Practice Address - Phone:617-920-4273
Practice Address - Fax:855-441-6941
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ONE HOME MEDICAL EQUIPMENT LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-01-24
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1001509OtherTX DEPARTMENT OF STATE HEALTH SERVICES
TX025049001Medicaid