Provider Demographics
NPI:1972512499
Name:JUDSON SQUARE MEDICAL SUPPLY INC
Entity Type:Organization
Organization Name:JUDSON SQUARE MEDICAL SUPPLY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:GRACE
Authorized Official - Middle Name:E
Authorized Official - Last Name:RAMOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-945-4722
Mailing Address - Street 1:339 S SEGUIN RD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:CONVERSE
Mailing Address - State:TX
Mailing Address - Zip Code:78109-2137
Mailing Address - Country:US
Mailing Address - Phone:210-945-4722
Mailing Address - Fax:210-945-4011
Practice Address - Street 1:339 S SEGUIN RD
Practice Address - Street 2:SUITE 4
Practice Address - City:CONVERSE
Practice Address - State:TX
Practice Address - Zip Code:78109-2137
Practice Address - Country:US
Practice Address - Phone:210-945-4722
Practice Address - Fax:210-945-4011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1222630001Medicare NSC