Provider Demographics
NPI:1871039008
Name:4D MEDICAL CONCEPTS LLC.
Entity Type:Organization
Organization Name:4D MEDICAL CONCEPTS LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LEONARD
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:DAVILA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-300-3701
Mailing Address - Street 1:317 WILLOW LOOP
Mailing Address - Street 2:
Mailing Address - City:CIBOLO
Mailing Address - State:TX
Mailing Address - Zip Code:78108-4298
Mailing Address - Country:US
Mailing Address - Phone:210-300-3701
Mailing Address - Fax:877-497-6972
Practice Address - Street 1:815 S SAINT MARYS ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78205-3408
Practice Address - Country:US
Practice Address - Phone:210-300-3701
Practice Address - Fax:877-497-6972
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-11
Last Update Date:2017-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies