Provider Demographics
NPI:1902834146
Name:EL VALLE MEDICAL SUPPLIES, LLC
Entity Type:Organization
Organization Name:EL VALLE MEDICAL SUPPLIES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / ADMINISTRATION
Authorized Official - Prefix:
Authorized Official - First Name:GENESIS
Authorized Official - Middle Name:AILEEN
Authorized Official - Last Name:TREVINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-849-2831
Mailing Address - Street 1:PO BOX 719
Mailing Address - Street 2:
Mailing Address - City:ROMA
Mailing Address - State:TX
Mailing Address - Zip Code:78584-0719
Mailing Address - Country:US
Mailing Address - Phone:956-849-2831
Mailing Address - Fax:956-849-2833
Practice Address - Street 1:4851 W US HIGHWAY 83
Practice Address - Street 2:
Practice Address - City:ROMA
Practice Address - State:TX
Practice Address - Zip Code:78584
Practice Address - Country:US
Practice Address - Phone:956-849-2831
Practice Address - Fax:956-849-2833
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-28
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0082506332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX178535401Medicaid
TX178535401Medicaid
TX178535402Medicaid