Provider Demographics
NPI:1760628473
Name:AZTECA DURABLE MEDICAL EQUIPMENT
Entity type:Organization
Organization Name:AZTECA DURABLE MEDICAL EQUIPMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:SEVERIANO
Authorized Official - Middle Name:
Authorized Official - Last Name:ORTIZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-565-2000
Mailing Address - Street 1:717 W 2ND ST
Mailing Address - Street 2:
Mailing Address - City:MERCEDES
Mailing Address - State:TX
Mailing Address - Zip Code:78570-2605
Mailing Address - Country:US
Mailing Address - Phone:956-565-2000
Mailing Address - Fax:956-565-2019
Practice Address - Street 1:717 W. 2ND. ST.
Practice Address - Street 2:
Practice Address - City:MERCEDES
Practice Address - State:TX
Practice Address - Zip Code:78570-2605
Practice Address - Country:US
Practice Address - Phone:956-565-2000
Practice Address - Fax:956-565-2019
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-30
Last Update Date:2011-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX6204180001Medicare NSC