Provider Demographics
NPI:1245416478
Name:VALLEY MEDICAL SUPPLY LLC.
Entity type:Organization
Organization Name:VALLEY MEDICAL SUPPLY LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANGER
Authorized Official - Prefix:MR
Authorized Official - First Name:RAMIRO
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-630-5999
Mailing Address - Street 1:200 E EXPRESSWAY 83
Mailing Address - Street 2:SUITE P
Mailing Address - City:PHARR
Mailing Address - State:TX
Mailing Address - Zip Code:78577-6507
Mailing Address - Country:US
Mailing Address - Phone:956-702-1100
Mailing Address - Fax:956-702-1104
Practice Address - Street 1:200 E EXPRESSWAY 83
Practice Address - Street 2:SUITE P
Practice Address - City:PHARR
Practice Address - State:TX
Practice Address - Zip Code:78577-6507
Practice Address - Country:US
Practice Address - Phone:956-702-1100
Practice Address - Fax:956-702-1104
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-17
Last Update Date:2010-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX197151702Medicaid
TX197151701Medicaid
TX197151702Medicaid