Provider Demographics
NPI:1912130931
Name:SAN ANTONIO MEDICAL SUPPLIES
Entity Type:Organization
Organization Name:SAN ANTONIO MEDICAL SUPPLIES
Other - Org Name:SAMS HOME MODIFICATIONS
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/PARTNER
Authorized Official - Prefix:MS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:REYNA
Authorized Official - Suffix:
Authorized Official - Credentials:OTHER
Authorized Official - Phone:210-737-7268
Mailing Address - Street 1:1500 FREDERICKSBURG RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78201-5029
Mailing Address - Country:US
Mailing Address - Phone:210-737-7267
Mailing Address - Fax:210-737-7262
Practice Address - Street 1:1500 FREDERICKSBURG RD
Practice Address - Street 2:SUITE B
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78201-5029
Practice Address - Country:US
Practice Address - Phone:210-737-7267
Practice Address - Fax:210-737-7262
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SAN ANTONIO MEDICAL SUPPLIES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-08-25
Last Update Date:2009-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0108615251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health