Provider Demographics
NPI:1992768717
Name:LONG TERM MEDICAL EQUIPMENT AND SUPPLIES
Entity type:Organization
Organization Name:LONG TERM MEDICAL EQUIPMENT AND SUPPLIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EMMANUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:IROANYA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-374-9080
Mailing Address - Street 1:111 W ANDERSON LN
Mailing Address - Street 2:D 206
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78752-1132
Mailing Address - Country:US
Mailing Address - Phone:512-374-9080
Mailing Address - Fax:512-374-0053
Practice Address - Street 1:111 W ANDERSON LN
Practice Address - Street 2:D 206
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78752-1132
Practice Address - Country:US
Practice Address - Phone:512-374-9080
Practice Address - Fax:512-374-0053
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-11
Last Update Date:2009-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0070596332B00000X, 332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX531697OtherBLUE CROSS BLUE SHIELD
TX168047202Medicaid
TX168047201Medicaid
4893400001Medicare NSC