Provider Demographics
NPI:1457771065
Name:MEDICO PS, LLC
Entity Type:Organization
Organization Name:MEDICO PS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:LANZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:682-502-4242
Mailing Address - Street 1:2140 E SOUTHLAKE BLVD
Mailing Address - Street 2:SUITE L-228
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-6516
Mailing Address - Country:US
Mailing Address - Phone:682-502-4242
Mailing Address - Fax:
Practice Address - Street 1:2140 E SOUTHLAKE BLVD
Practice Address - Street 2:SUITE L-228
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-6516
Practice Address - Country:US
Practice Address - Phone:682-502-4242
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-22
Last Update Date:2014-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies