Provider Demographics
NPI:1881784155
Name:SANTE MEDICAL SUPPLY LLC
Entity type:Organization
Organization Name:SANTE MEDICAL SUPPLY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:GRACIELA
Authorized Official - Middle Name:
Authorized Official - Last Name:GUERRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-542-1988
Mailing Address - Street 1:1284 PAREDES LINE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78521-1715
Mailing Address - Country:US
Mailing Address - Phone:956-542-1988
Mailing Address - Fax:956-542-0988
Practice Address - Street 1:1284 PAREDES LINE
Practice Address - Street 2:SUITE 1
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78521-1715
Practice Address - Country:US
Practice Address - Phone:956-542-1988
Practice Address - Fax:956-542-0988
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-14
Last Update Date:2010-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX332B00000X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0101608Medicaid
TX175275002Medicaid
TX175275001Medicaid
TX6042080001Medicare NSC
TX175275001Medicaid