1972512499 NPI number — JUDSON SQUARE MEDICAL SUPPLY INC

Table of content: (NPI 1972512499)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972512499 NPI number — JUDSON SQUARE MEDICAL SUPPLY INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JUDSON SQUARE MEDICAL SUPPLY 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:
Provider Other Organization Name Type Code:
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:
1972512499
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
339 S SEGUIN RD
Provider Second Line Business Mailing Address:
SUITE 4
Provider Business Mailing Address City Name:
CONVERSE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78109-2137
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-945-4722
Provider Business Mailing Address Fax Number:
210-945-4011

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
339 S SEGUIN RD
Provider Second Line Business Practice Location Address:
SUITE 4
Provider Business Practice Location Address City Name:
CONVERSE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78109-2137
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-945-4722
Provider Business Practice Location Address Fax Number:
210-945-4011
Provider Enumeration Date:
08/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
RAMOS
Authorized Official First Name:
GRACE
Authorized Official Middle Name:
E
Authorized Official Title or Position:
PRESIDENT/MANAGER
Authorized Official Telephone Number:
210-945-4722

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  13 , 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)





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