Provider Demographics
NPI:1902054307
Name:SOUTH TEXAS C-PAP STORE,LLC
Entity Type:Organization
Organization Name:SOUTH TEXAS C-PAP STORE,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GILBERT
Authorized Official - Middle Name:JOSE
Authorized Official - Last Name:GONZALES
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:210-651-4940
Mailing Address - Street 1:19115 FM 2252 STE 5
Mailing Address - Street 2:
Mailing Address - City:GARDEN RIDGE
Mailing Address - State:TX
Mailing Address - Zip Code:78266-2578
Mailing Address - Country:US
Mailing Address - Phone:210-651-4940
Mailing Address - Fax:210-657-0301
Practice Address - Street 1:19115 FM 2252 STE 5
Practice Address - Street 2:
Practice Address - City:GARDEN RIDGE
Practice Address - State:TX
Practice Address - Zip Code:78266-2578
Practice Address - Country:US
Practice Address - Phone:210-651-4940
Practice Address - Fax:210-657-0301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-28
Last Update Date:2008-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0105916332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies