Provider Demographics
NPI:1740287358
Name:ROSIE L RAY
Entity type:Organization
Organization Name:ROSIE L RAY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:RALPH
Authorized Official - Middle Name:J
Authorized Official - Last Name:DREYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-593-0400
Mailing Address - Street 1:7959 FREDERICKSBURG RD
Mailing Address - Street 2:SUITE111
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3430
Mailing Address - Country:US
Mailing Address - Phone:210-593-0400
Mailing Address - Fax:210-593-0904
Practice Address - Street 1:3562 KNICKERBOCKER RD
Practice Address - Street 2:
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76904-7611
Practice Address - Country:US
Practice Address - Phone:325-949-9956
Practice Address - Fax:325-223-2933
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-29
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24616264206332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX146325901Medicaid
TX146325902Medicaid
TX4113160001Medicare NSC