Provider Demographics
NPI:1720100829
Name:MARQUEZ MEDICAL SUPPLY
Entity Type:Organization
Organization Name:MARQUEZ MEDICAL SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:EDELMIRA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:915-850-3652
Mailing Address - Street 1:1580 GEORGE DIETER DR
Mailing Address - Street 2:SUITE 305
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-7612
Mailing Address - Country:US
Mailing Address - Phone:915-858-6513
Mailing Address - Fax:915-856-8617
Practice Address - Street 1:1580 GEORGE DIETER DR
Practice Address - Street 2:STE 305
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-7612
Practice Address - Country:US
Practice Address - Phone:915-858-6513
Practice Address - Fax:915-856-8617
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-06
Last Update Date:2008-02-21
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
TX172959202Medicaid
TX172959201Medicaid
TX172959202Medicaid