Provider Demographics
NPI:1982786638
Name:EQUIMEDIC
Entity type:Organization
Organization Name:EQUIMEDIC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:HERNANDO
Authorized Official - Middle Name:
Authorized Official - Last Name:CASTANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-430-5670
Mailing Address - Street 1:5405 BANDERA RD
Mailing Address - Street 2:STE 127
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78238-1954
Mailing Address - Country:US
Mailing Address - Phone:210-757-0355
Mailing Address - Fax:210-647-7877
Practice Address - Street 1:5405 BANDERA RD
Practice Address - Street 2:STE 127
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78238-1949
Practice Address - Country:US
Practice Address - Phone:210-757-0355
Practice Address - Fax:210-647-7877
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-20
Last Update Date:2010-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0082152332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX180620001Medicaid
TX5695430001Medicare ID - Type Unspecified