Provider Demographics
NPI:1205082658
Name:PL MEDICAL SUPPLY, INC
Entity type:Organization
Organization Name:PL MEDICAL SUPPLY, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:MRS
Authorized Official - First Name:NOEMI
Authorized Official - Middle Name:
Authorized Official - Last Name:VILLARREAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-580-7577
Mailing Address - Street 1:2034 E GRIFFIN PKWY
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78572-3223
Mailing Address - Country:US
Mailing Address - Phone:956-580-7577
Mailing Address - Fax:956-580-9073
Practice Address - Street 1:8899 ALAMEDA AVE STE 117
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79907-6288
Practice Address - Country:US
Practice Address - Phone:915-858-8552
Practice Address - Fax:915-858-3664
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PRODUCTIVE LIFE MEDICAL SUPPLY INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-08-15
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
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
TX194744202Medicaid
TX194744201Medicaid
TX5917940002Medicare NSC