Provider Demographics
NPI:1770681744
Name:MEDICAL SUPPLY DEPOT
Entity Type:Organization
Organization Name:MEDICAL SUPPLY DEPOT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:LAURO
Authorized Official - Middle Name:
Authorized Official - Last Name:GARZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-972-0011
Mailing Address - Street 1:200 N MCCOLL RD
Mailing Address - Street 2:UNIT B
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78501-9359
Mailing Address - Country:US
Mailing Address - Phone:956-972-0011
Mailing Address - Fax:956-972-0018
Practice Address - Street 1:200 N MCCOLL RD
Practice Address - Street 2:UNIT B
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78501-9359
Practice Address - Country:US
Practice Address - Phone:956-972-0011
Practice Address - Fax:956-972-0018
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM18381758Medicaid
NM18381758Medicaid