Fayette Medical Supply, Inc.

Primary specialty

Oxygen Equipment & Supplies (DME)Taxonomy code 332BX2000X

License

0031424 Issued in TX

Legal business name

FAYETTE MEDICAL SUPPLY, INC.

Practice address

362 E Travis St
La Grange, TX 78945-2619

Phone

(979) 968-6680

Fax

(979) 404-6082

NPI assigned

Apr 17, 2006

Last updated

Oct 2, 2025By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Jonathan Hernandez

Title

Operations Manager

Phone

(979) 968-6680

Specialties & licenses 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

• Fayette Medical Supply, Inc.

  • Oxygen Equipment & Supplies (DME)
  • Bastrop, TX
  • NPI 1538124953

  7517085004

  Same PAC ID

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

Tax ID family

Fayette Medical Supply2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Fayette Medical Supply, Inc.

  • Oxygen Equipment & Supplies (DME)
  • Bastrop, TX
  • NPI 1538124953
  NPD tax ID

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Patrick Brian Boardman, ATP

  • Assistive Technology Practitioner Rehabilitation Counselor
  • Missouri City, TX
  • NPI 1538632435
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1145232000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1759363200000",
    "number": "1295790061",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 939",
            "city": "LA GRANGE",
            "state": "TX",
            "postal_code": "789450939",
            "telephone_number": "979-968-6680",
            "fax_number": "979-859-7184"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "362 E TRAVIS ST",
            "city": "LA GRANGE",
            "state": "TX",
            "postal_code": "789452619",
            "telephone_number": "979-968-6680",
            "fax_number": "979-404-6082"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAYETTE MEDICAL SUPPLY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-17",
        "last_updated": "2025-10-02",
        "certification_date": "2025-10-02",
        "status": "A",
        "authorized_official_last_name": "HERNANDEZ",
        "authorized_official_first_name": "JONATHAN",
        "authorized_official_title_or_position": "OPERATIONS MANAGER",
        "authorized_official_telephone_number": "979-968-6680"
    },
    "taxonomies": [
        {
            "code": "225CA2500X",
            "taxonomy_group": "",
            "desc": "Rehabilitation Counselor, Assistive Technology Supplier",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "332BX2000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Oxygen Equipment & Supplies",
            "state": "TX",
            "license": "0031424",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "086664201",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jennifer J Emmel, PA-C
• Laura Eschenburg, L.P.T.
• Fast Track Urgent Care - la Grange (Fast Aid Urgent Care - La Grange)
• Fayette County (Fayette County Emergency Medical Services)
• Fayette County
• Marc A Fitzpatrick, D.C.
• Samantha Fleming
• Angelia Kay Foreman
• Fresh Smiles PLLC
• Fresh Smiles-la Grange PLLC

• Oxygen Equipment & Supplies (DME) in La Grange, TX
• Providers in La Grange, TX by specialty
• Oxygen Equipment & Supplies (DME) in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.