Provider Demographics
NPI:1922186436
Name:JORGE L. PENA INC
Entity Type:Organization
Organization Name:JORGE L. PENA INC
Other - Org Name:OX-Y-CARE MEDICAL EQUIPMENT AND SUPPLES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:L
Authorized Official - Last Name:PENA
Authorized Official - Suffix:
Authorized Official - Credentials:RRT,BBA
Authorized Official - Phone:956-928-1720
Mailing Address - Street 1:510 S BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78501-4904
Mailing Address - Country:US
Mailing Address - Phone:956-928-1720
Mailing Address - Fax:956-928-1730
Practice Address - Street 1:510 S BROADWAY ST
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78501-4904
Practice Address - Country:US
Practice Address - Phone:956-928-1720
Practice Address - Fax:956-928-1730
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0076385332B00000X, 332BP3500X, 332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX169330101Medicaid
TX169330102Medicaid
TX169330102Medicaid