Basic Information
| Provider Information | |||||||||
| NPI: | 1851614242 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FRESCAS MEDICAL SUPPLIES LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | U&T MEDICAL & RESPIRATORY SUPPLIES | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 509 GILES ROAD STE C | ||||||||
| Address2: | |||||||||
| City: | EL PASO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 799152725 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9155953941 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 509 GILES ROAD | ||||||||
| Address2: | SUITE C | ||||||||
| City: | EL PASO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 799152725 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9155999000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/12/2010 | ||||||||
| LastUpdateDate: | 10/12/2010 | ||||||||
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| AuthorizedOfficialLastName: | FRESCAS | ||||||||
| AuthorizedOfficialFirstName: | ROSINA | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT/ OWNER | ||||||||
| AuthorizedOfficialTelephone: | 9155953941 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332BX2000X | Y | Suppliers | Durable Medical Equipment & Medical Supplies | Oxygen Equipment & Supplies |
ID Information
| ID | Type | State | Issuer | Description | 213933902 | 05 | TX | MEDICAID |