Provider Demographics
NPI:1205449550
Name:MID VALLEY MEDICAL SUPPLIES LLC
Entity type:Organization
Organization Name:MID VALLEY MEDICAL SUPPLIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAVIER
Authorized Official - Middle Name:EDUARDO
Authorized Official - Last Name:CAVAZOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-246-9831
Mailing Address - Street 1:111 S OHIO AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:MERCEDES
Mailing Address - State:TX
Mailing Address - Zip Code:78570-2612
Mailing Address - Country:US
Mailing Address - Phone:956-246-9831
Mailing Address - Fax:
Practice Address - Street 1:111 S OHIO AVE STE 1
Practice Address - Street 2:
Practice Address - City:MERCEDES
Practice Address - State:TX
Practice Address - Zip Code:78570-2612
Practice Address - Country:US
Practice Address - Phone:956-246-9831
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-26
Last Update Date:2020-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies