Provider Demographics
NPI:1770753030
Name:DISTRICT EMERGENCY MEDICAL SUPPLIES
Entity type:Organization
Organization Name:DISTRICT EMERGENCY MEDICAL SUPPLIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JESUS
Authorized Official - Middle Name:EDWARDO
Authorized Official - Last Name:CORPUS
Authorized Official - Suffix:
Authorized Official - Credentials:PARAMEDIC
Authorized Official - Phone:956-787-3795
Mailing Address - Street 1:200 E EXPY 83 STE M
Mailing Address - Street 2:
Mailing Address - City:PHARR
Mailing Address - State:TX
Mailing Address - Zip Code:78577-6506
Mailing Address - Country:US
Mailing Address - Phone:956-787-3795
Mailing Address - Fax:956-787-3796
Practice Address - Street 1:200 E EXPY 83 STE M
Practice Address - Street 2:
Practice Address - City:PHARR
Practice Address - State:TX
Practice Address - Zip Code:78577-6506
Practice Address - Country:US
Practice Address - Phone:956-787-3795
Practice Address - Fax:956-787-3796
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-03
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0094180332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX6047120001Medicare NSC