1588656227 NPI number — DME DEPOT LTD

Table of content: (NPI 1588656227)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588656227 NPI number — DME DEPOT LTD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DME DEPOT LTD
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:
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:
1588656227
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/19/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5233 I H 37
Provider Second Line Business Mailing Address:
SUITE B18
Provider Business Mailing Address City Name:
CORPUS CHRISTI
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78408-2521
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
361-992-5353
Provider Business Mailing Address Fax Number:
361-992-5474

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5233 I H 37
Provider Second Line Business Practice Location Address:
SUITE B18
Provider Business Practice Location Address City Name:
CORPUS CHRISTI
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78408-2521
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
361-992-5353
Provider Business Practice Location Address Fax Number:
361-992-5474
Provider Enumeration Date:
08/18/2005

Additional Information

Authorized Official

Authorized Official Last Name:
TOMERLIN
Authorized Official First Name:
MARTIN
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT GENERAL MANAGER
Authorized Official Telephone Number:
210-564-0100

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  0071686 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332BC3200X , with the licence number: 0071686 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BD1200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BN1400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BP3500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BX2000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 164195301 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 164195302 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 531558 . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 164195304 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 164195303 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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