Provider Demographics
NPI:1700126489
Name:MAINSTREAM MEDICAL PLLC
Entity Type:Organization
Organization Name:MAINSTREAM MEDICAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROY
Authorized Official - Middle Name:VINCENT
Authorized Official - Last Name:MORALES
Authorized Official - Suffix:
Authorized Official - Credentials:RRT
Authorized Official - Phone:915-227-0536
Mailing Address - Street 1:7061 PORTUGAL DR APT A
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-2366
Mailing Address - Country:US
Mailing Address - Phone:915-227-0536
Mailing Address - Fax:
Practice Address - Street 1:7061 PORTUGAL DR APT A
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912
Practice Address - Country:US
Practice Address - Phone:915-227-0536
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-18
Last Update Date:2013-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies