Provider Demographics
NPI:1912919317
Name:SP MEDICAL SUPPLY,LLC
Entity Type:Organization
Organization Name:SP MEDICAL SUPPLY,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:KARLA
Authorized Official - Middle Name:P
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-520-7496
Mailing Address - Street 1:6737 POSS RD STE 204
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78238-2298
Mailing Address - Country:US
Mailing Address - Phone:210-520-7496
Mailing Address - Fax:210-681-1916
Practice Address - Street 1:6737 POSS RD STE 204
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78238-2298
Practice Address - Country:US
Practice Address - Phone:210-520-7496
Practice Address - Fax:210-681-1916
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-13
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX5672440001Medicare ID - Type Unspecified