Provider Demographics
NPI:1023529690
Name:AMERICAN GENERAL MERCHANTS INC.
Entity type:Organization
Organization Name:AMERICAN GENERAL MERCHANTS INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:IDRIS
Authorized Official - Middle Name:ELIJA
Authorized Official - Last Name:SALIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-415-5554
Mailing Address - Street 1:3213 INTERSTATE 30 STE 108
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75150-2603
Mailing Address - Country:US
Mailing Address - Phone:972-270-0500
Mailing Address - Fax:972-674-2944
Practice Address - Street 1:3213 INTERSTATE 30 STE 108
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-2603
Practice Address - Country:US
Practice Address - Phone:972-270-0500
Practice Address - Fax:972-674-2944
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-23
Last Update Date:2020-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332BD1200XSuppliersDurable Medical Equipment & Medical SuppliesDialysis Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1002022OtherTEXAS DEVICE DISTRIBUTOR LICENSE
TX3925968Medicaid