Provider Demographics
NPI:1255382024
Name:ERGO MEDIQ,LTD.
Entity type:Organization
Organization Name:ERGO MEDIQ,LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SONIA
Authorized Official - Middle Name:YVONNE
Authorized Official - Last Name:ANCISO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-630-9950
Mailing Address - Street 1:929 E ESPERANZA AVE UNIT 24
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78501-1472
Mailing Address - Country:US
Mailing Address - Phone:956-212-8005
Mailing Address - Fax:
Practice Address - Street 1:929 E ESPERANZA AVE UNIT 24
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78501-1472
Practice Address - Country:US
Practice Address - Phone:956-630-9950
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-15
Last Update Date:2015-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX183926801Medicaid
TX183926802Medicaid
TX5706700001Medicare NSC