Provider Demographics
NPI:1215113238
Name:ALL VALLEY MEDICAL SUPPLY
Entity type:Organization
Organization Name:ALL VALLEY MEDICAL SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:M
Authorized Official - Last Name:FLORES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-781-5800
Mailing Address - Street 1:200 E EXPRESSWAY 83 STE L2
Mailing Address - Street 2:
Mailing Address - City:PHARR
Mailing Address - State:TX
Mailing Address - Zip Code:78577-6507
Mailing Address - Country:US
Mailing Address - Phone:956-781-5800
Mailing Address - Fax:956-781-5873
Practice Address - Street 1:200 E EXPRESSWAY 83 STE L2
Practice Address - Street 2:
Practice Address - City:PHARR
Practice Address - State:TX
Practice Address - Zip Code:78577-6507
Practice Address - Country:US
Practice Address - Phone:956-781-5800
Practice Address - Fax:956-781-5873
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-22
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0079939332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX158773501Medicaid
TX158773502Medicaid
VT1356423263Medicare NSC
TX158773502Medicaid