Provider Demographics
NPI:1942449434
Name:ROLAND GUERRA
Entity Type:Organization
Organization Name:ROLAND GUERRA
Other - Org Name:PRIME MEDICAL SUPPLY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROLAND
Authorized Official - Middle Name:
Authorized Official - Last Name:GUERRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-607-3474
Mailing Address - Street 1:924 W NOLANA LOOP
Mailing Address - Street 2:C
Mailing Address - City:PHARR
Mailing Address - State:TX
Mailing Address - Zip Code:78577-7931
Mailing Address - Country:US
Mailing Address - Phone:956-782-5555
Mailing Address - Fax:
Practice Address - Street 1:924 W NOLANA LOOP
Practice Address - Street 2:C
Practice Address - City:PHARR
Practice Address - State:TX
Practice Address - Zip Code:78577-7931
Practice Address - Country:US
Practice Address - Phone:956-782-5555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-06
Last Update Date:2011-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies