Provider Demographics
NPI:1912049370
Name:AMIGO DURABLE MEDICAL EQUIPMENT LLC
Entity type:Organization
Organization Name:AMIGO DURABLE MEDICAL EQUIPMENT LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:JAIME
Authorized Official - Middle Name:JAVIER
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-968-8282
Mailing Address - Street 1:538 S TEXAS BLVD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:WESLACO
Mailing Address - State:TX
Mailing Address - Zip Code:78596-6202
Mailing Address - Country:US
Mailing Address - Phone:956-968-8282
Mailing Address - Fax:956-968-7211
Practice Address - Street 1:538 S TEXAS BLVD
Practice Address - Street 2:SUITE 4
Practice Address - City:WESLACO
Practice Address - State:TX
Practice Address - Zip Code:78596-6202
Practice Address - Country:US
Practice Address - Phone:956-968-8282
Practice Address - Fax:956-968-7211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0086177332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX5604140001Medicare ID - Type Unspecified