NPIMap

Organization Active NPI

Brackettville Home Medical Supply LLC

  • Durable Medical Equipment & Medical Supplies
  • Brackettville, TX
National Provider Identifier
1528046836
Registry record updated Aug 20, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
Legal business name
BRACKETTVILLE HOME MEDICAL SUPPLY LLC
Practice address
302 Military Dr
Brackettville, TX 78832
Phone
(830) 563-2200
Fax
(830) 563-2206
NPI assigned
Jan 6, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 20, 2008

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

Authorized official

Name
Kenneth Edward Wiese
Title
General Manager
Phone
(830) 775-4060

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X Primary
Parenteral & Enteral Nutrition Supplies (DME) 332BP3500X 0082284 TX
Oxygen Equipment & Supplies (DME) 332BX2000X

Addresses

Primary practice location

302 Military Dr
Brackettville, TX 78832

Mailing address

1011 E 7TH St
Del Rio, TX 78840-4162
Phone (830) 775-4060

Other identifiers 3

IdentifierTypeStateIssuer
507642OtherTXINSURANCE PROVIDER ID
177105702MedicaidTX
177105701MedicaidTX

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1136505600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1219190400000",
    "number": "1528046836",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1011 E 7TH ST",
            "city": "DEL RIO",
            "state": "TX",
            "postal_code": "788404162",
            "telephone_number": "830-775-4060",
            "fax_number": "730-775-4038"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "302 MILITARY DR",
            "city": "BRACKETTVILLE",
            "state": "TX",
            "postal_code": "78832",
            "telephone_number": "830-563-2200",
            "fax_number": "830-563-2206"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRACKETTVILLE HOME MEDICAL SUPPLY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-01-06",
        "last_updated": "2008-08-20",
        "status": "A",
        "authorized_official_last_name": "WIESE",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_middle_name": "EDWARD",
        "authorized_official_title_or_position": "GENERAL MANAGER",
        "authorized_official_telephone_number": "830-775-4060"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "332BP3500X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Parenteral & Enteral Nutrition",
            "state": "TX",
            "license": "0082284",
            "primary": false
        },
        {
            "code": "332BX2000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Oxygen Equipment & Supplies",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INSURANCE PROVIDER ID",
            "identifier": "507642",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "177105702",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "177105701",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Brackettville, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.