1336155175 NPI number — PERFORMANCE DME AND MEDICAL SUPPLY, ALLIANCE DME AND MEDICAL

Table of content: (NPI 1336155175)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336155175 NPI number — PERFORMANCE DME AND MEDICAL SUPPLY, ALLIANCE DME AND MEDICAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PERFORMANCE DME AND MEDICAL SUPPLY, ALLIANCE DME AND MEDICAL
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:
6
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:
1336155175
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/16/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2445 MIDWAY RD
Provider Second Line Business Mailing Address:
SUITE # 103
Provider Business Mailing Address City Name:
CARROLLTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75006-2555
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-357-5913
Provider Business Mailing Address Fax Number:
214-357-8204

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2445 MIDWAY RD
Provider Second Line Business Practice Location Address:
SUITE # 103
Provider Business Practice Location Address City Name:
CARROLLTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75006-2555
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-357-5913
Provider Business Practice Location Address Fax Number:
214-357-8204
Provider Enumeration Date:
08/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BUCK
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
DALE
Authorized Official Title or Position:
PRESIDENT,OWNER
Authorized Official Telephone Number:
214-357-5913

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  0088008 , 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)

  • Identifier: 0088008 . This is a "STATE LICENSE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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