Provider Demographics
NPI:1891703856
Name:BRENDA SUE WIMPEE
Entity Type:Organization
Organization Name:BRENDA SUE WIMPEE
Other - Org Name:SAN ANGELO HOME MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:WIMPEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:325-949-2612
Mailing Address - Street 1:2525 S JOHNSON
Mailing Address - Street 2:SUITE A
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76904
Mailing Address - Country:US
Mailing Address - Phone:325-949-2612
Mailing Address - Fax:
Practice Address - Street 1:2525 S JOHNSON
Practice Address - Street 2:SUITE A
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76904
Practice Address - Country:US
Practice Address - Phone:325-949-2612
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-04
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX010569401OtherNHIC
TX011356501Medicaid
TX530545OtherBCBS
TX011356501Medicaid