Provider Demographics
NPI:1760700546
Name:PA MI GENTE DME LLC
Entity Type:Organization
Organization Name:PA MI GENTE DME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:BARBOZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-463-6962
Mailing Address - Street 1:200 W EXPRESSWAY 83
Mailing Address - Street 2:STE E
Mailing Address - City:SAN JUAN
Mailing Address - State:TX
Mailing Address - Zip Code:78589-3641
Mailing Address - Country:US
Mailing Address - Phone:956-783-9500
Mailing Address - Fax:
Practice Address - Street 1:200 W EXPRESSWAY 83
Practice Address - Street 2:STE E
Practice Address - City:SAN JUAN
Practice Address - State:TX
Practice Address - Zip Code:78589-3641
Practice Address - Country:US
Practice Address - Phone:956-783-9500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-04
Last Update Date:2011-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX219669301Medicaid
TX219669302Medicaid
TX6472040001Medicare NSC