Provider Demographics
NPI:1992963615
Name:FUNDAMENTAL MEDICAL SUPPLIES LLC
Entity type:Organization
Organization Name:FUNDAMENTAL MEDICAL SUPPLIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:SAEGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-590-8800
Mailing Address - Street 1:4019 STAHL RD
Mailing Address - Street 2:STE 210
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78217-1669
Mailing Address - Country:US
Mailing Address - Phone:210-590-8800
Mailing Address - Fax:210-200-6047
Practice Address - Street 1:4019 STAHL RD
Practice Address - Street 2:STE 210
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78217-1669
Practice Address - Country:US
Practice Address - Phone:210-590-8800
Practice Address - Fax:210-200-6047
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-29
Last Update Date:2008-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX6127330001Medicare NSC