Provider Demographics
NPI:1427468099
Name:ANGELIC MEDICAL DESIGNS LLC
Entity type:Organization
Organization Name:ANGELIC MEDICAL DESIGNS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:J
Authorized Official - Last Name:RIOS
Authorized Official - Suffix:
Authorized Official - Credentials:LVN
Authorized Official - Phone:210-414-9014
Mailing Address - Street 1:7043 BANDERA RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78238-1266
Mailing Address - Country:US
Mailing Address - Phone:210-384-9201
Mailing Address - Fax:201-384-9212
Practice Address - Street 1:7043 BANDERA RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78238-1266
Practice Address - Country:US
Practice Address - Phone:210-384-9201
Practice Address - Fax:201-384-9212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-05
Last Update Date:2015-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1001404332B00000X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX344504101Medicaid
TX344504102Medicaid
TX344504102Medicaid