Provider Demographics
NPI:1851501969
Name:MEDI-TRONICS
Entity Type:Organization
Organization Name:MEDI-TRONICS
Other - Org Name:MEDI- TRONICS
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JIMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:CARDENAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-785-8112
Mailing Address - Street 1:1717 CAPITOL AVE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78201-4643
Mailing Address - Country:US
Mailing Address - Phone:210-785-8112
Mailing Address - Fax:210-785-8113
Practice Address - Street 1:1717 CAPITOL AVE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78201-4643
Practice Address - Country:US
Practice Address - Phone:210-785-8112
Practice Address - Fax:210-785-8113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2013-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0039917332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX014599OtherADVANTAGE BY SUPERIOR
TX533568OtherBLUECROSS BLUESHIELD OF TX
TXQMP000003944245OtherMOLINA HEALTHCARE
TX016799101Medicaid
TX1414840001OtherSUPERIOR STAR PLUS
TX533568OtherBLUECROSS BLUESHIELD OF TX