Provider Demographics
NPI:1972658102
Name:VISTA HILLS MEDICAL EQUIPMENT CORP.
Entity Type:Organization
Organization Name:VISTA HILLS MEDICAL EQUIPMENT CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:FERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:CFO
Authorized Official - Phone:915-494-5027
Mailing Address - Street 1:1721 N LEE TREVINO DR
Mailing Address - Street 2:SUITE 101A
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-4521
Mailing Address - Country:US
Mailing Address - Phone:915-592-7976
Mailing Address - Fax:915-592-3555
Practice Address - Street 1:1721 N LEE TREVINO DR
Practice Address - Street 2:SUITE 101A
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-4521
Practice Address - Country:US
Practice Address - Phone:915-592-7976
Practice Address - Fax:915-592-3555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2010-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0053948332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX148006301Medicare ID - Type UnspecifiedMEDICAID PROVIDER ID
TX4155890001Medicare NSC