Provider Demographics
NPI:1770712150
Name:MISSION MEDICAL EQUIPMENT & DIABETIC SUPPLIES
Entity type:Organization
Organization Name:MISSION MEDICAL EQUIPMENT & DIABETIC SUPPLIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:OSCAR
Authorized Official - Middle Name:
Authorized Official - Last Name:ROMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-638-0128
Mailing Address - Street 1:900 PLAZA DR
Mailing Address - Street 2:SUITE 4-B
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78572-6045
Mailing Address - Country:US
Mailing Address - Phone:956-583-0363
Mailing Address - Fax:956-583-0397
Practice Address - Street 1:900 PLAZA DR
Practice Address - Street 2:SUITE 4-B
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-6045
Practice Address - Country:US
Practice Address - Phone:956-583-0363
Practice Address - Fax:956-583-0397
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-07
Last Update Date:2009-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies