Provider Demographics
NPI:1720301401
Name:AMIGOMED, LLC
Entity Type:Organization
Organization Name:AMIGOMED, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PEARY
Authorized Official - Middle Name:
Authorized Official - Last Name:PERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-302-6027
Mailing Address - Street 1:12808 W. AIRPORT
Mailing Address - Street 2:SUITE 325 C
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77478
Mailing Address - Country:US
Mailing Address - Phone:281-302-6027
Mailing Address - Fax:832-886-4268
Practice Address - Street 1:12808 W. AIRPORT
Practice Address - Street 2:325 C
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478
Practice Address - Country:US
Practice Address - Phone:281-302-6027
Practice Address - Fax:832-886-4268
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-09
Last Update Date:2013-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1000364332B00000X
TX332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2144289(01)Medicaid
TX533351OtherBCBS PIN
TX214428901Medicaid
TX533351OtherBCBS PIN