Provider Demographics
NPI:1710951017
Name:RESTORATION MEDICAL EQUIPMENT & SUPPLY CO. LLC
Entity Type:Organization
Organization Name:RESTORATION MEDICAL EQUIPMENT & SUPPLY CO. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:E
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:956-753-6767
Mailing Address - Street 1:6801 MCPHERSON RD
Mailing Address - Street 2:STE 103
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78041-6403
Mailing Address - Country:US
Mailing Address - Phone:956-753-6767
Mailing Address - Fax:956-753-6753
Practice Address - Street 1:6801 MCPHERSON RD
Practice Address - Street 2:STE 103
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-6403
Practice Address - Country:US
Practice Address - Phone:956-753-6767
Practice Address - Fax:956-753-6753
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-14
Last Update Date:2012-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0067100332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1630154-02Medicaid
TX1630154-01Medicaid
TX4831890001Medicare NSC