Provider Demographics
NPI:1336360080
Name:PROFESSIONAL MEDICAL SUPPLIES
Entity type:Organization
Organization Name:PROFESSIONAL MEDICAL SUPPLIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:DELAGARZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-565-6262
Mailing Address - Street 1:4106 N 22ND ST
Mailing Address - Street 2:STE3
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-4147
Mailing Address - Country:US
Mailing Address - Phone:956-565-6262
Mailing Address - Fax:956-565-6265
Practice Address - Street 1:4106 N 22ND ST
Practice Address - Street 2:STE3
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-4147
Practice Address - Country:US
Practice Address - Phone:956-565-6262
Practice Address - Fax:956-565-6265
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX32016424254332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX5347110001Medicare ID - Type Unspecified