Provider Demographics
NPI:1043437353
Name:FIDEL G HUERTA JR INC
Entity type:Organization
Organization Name:FIDEL G HUERTA JR INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:FIDEL
Authorized Official - Middle Name:G
Authorized Official - Last Name:HUERTA
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:210-433-5400
Mailing Address - Street 1:2115 PLEASANTON RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78221-1321
Mailing Address - Country:US
Mailing Address - Phone:210-433-5400
Mailing Address - Fax:
Practice Address - Street 1:700 S ZARZAMORA ST
Practice Address - Street 2:SUITE 100
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78207-5255
Practice Address - Country:US
Practice Address - Phone:210-433-5400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16707332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1164890003Medicare ID - Type UnspecifiedMEDICARE IDENTIFIER