Provider Demographics
NPI:1154011294
Name:SOUTH TEXAS ORTHOPEDIC SHOES LLC
Entity type:Organization
Organization Name:SOUTH TEXAS ORTHOPEDIC SHOES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ILIANA
Authorized Official - Middle Name:LUNA
Authorized Official - Last Name:MARQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-998-1178
Mailing Address - Street 1:605 J HERNANDEZ ST
Mailing Address - Street 2:
Mailing Address - City:PROGRESO LAKES
Mailing Address - State:TX
Mailing Address - Zip Code:78596-2095
Mailing Address - Country:US
Mailing Address - Phone:956-998-1178
Mailing Address - Fax:956-446-8182
Practice Address - Street 1:1125 JAMES ST STE G
Practice Address - Street 2:
Practice Address - City:WESLACO
Practice Address - State:TX
Practice Address - Zip Code:78596-6657
Practice Address - Country:US
Practice Address - Phone:956-998-1178
Practice Address - Fax:956-446-8182
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-11
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies