1093932774 NPI number — OCEAN VIEW DURABLE MEDICAL EQUIPMENT, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093932774 NPI number — OCEAN VIEW DURABLE MEDICAL EQUIPMENT, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OCEAN VIEW DURABLE MEDICAL EQUIPMENT, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
OCEAN VIEW DURABLE MEDICAL EQUIPMENT, INC
Provider Other Organization Name Type Code:
4
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1093932774
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/02/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4639 CORONA DR
Provider Second Line Business Mailing Address:
SUITE 36
Provider Business Mailing Address City Name:
CORPUS CHRISTI
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78411-5401
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
361-991-9200
Provider Business Mailing Address Fax Number:
361-991-9201

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4639 CORONA DR
Provider Second Line Business Practice Location Address:
SUITE 36
Provider Business Practice Location Address City Name:
CORPUS CHRISTI
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78411-5401
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
361-991-9200
Provider Business Practice Location Address Fax Number:
361-991-9201
Provider Enumeration Date:
04/20/2007

Additional Information

Authorized Official

Authorized Official Last Name:
PEREZ
Authorized Official First Name:
EDUARDO
Authorized Official Middle Name:
I
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
361-991-9200

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  0097089 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 191620702 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 191620701 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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