Provider Demographics
NPI:1841359650
Name:Y2K MEDICAL SUPPLY
Entity type:Organization
Organization Name:Y2K MEDICAL SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELLILIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DE LEON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-584-8925
Mailing Address - Street 1:618 E 9TH ST
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78572-4206
Mailing Address - Country:US
Mailing Address - Phone:956-584-8925
Mailing Address - Fax:956-583-0221
Practice Address - Street 1:618 E 9TH ST
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-4206
Practice Address - Country:US
Practice Address - Phone:956-584-8925
Practice Address - Fax:956-583-0221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1297210001332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1297210001Medicare ID - Type UnspecifiedDURABLE MEDICAL EQUIPMENT