Provider Demographics
NPI:1962683482
Name:H & S CHAMPS MEDICAL LTD
Entity Type:Organization
Organization Name:H & S CHAMPS MEDICAL LTD
Other - Org Name:CHAMPS MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-614-1414
Mailing Address - Street 1:7718 LOUIS PASTEUR DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3402
Mailing Address - Country:US
Mailing Address - Phone:210-614-1414
Mailing Address - Fax:
Practice Address - Street 1:205 N KING ST
Practice Address - Street 2:STE A
Practice Address - City:SEGUIN
Practice Address - State:TX
Practice Address - Zip Code:78155-5836
Practice Address - Country:US
Practice Address - Phone:830-303-0267
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:H & S CHAMPS MEDICAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-11-27
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0046884332B00000X, 332BP3500X, 332BX2000X
TX0046750332B00000X, 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
TX142484802Medicaid
TX141825301Medicaid
TX142484801Medicaid
TX141825301Medicaid