1922292325 NPI number — LONE STAR DME SUPPLY LLC

Table of content: (NPI 1922292325)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922292325 NPI number — LONE STAR DME SUPPLY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LONE STAR DME SUPPLY LLC
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:
1922292325
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/06/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2227 HALTOM RD
Provider Second Line Business Mailing Address:
SUITE G
Provider Business Mailing Address City Name:
HALTOM CITY
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76117-5037
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
817-838-8940
Provider Business Mailing Address Fax Number:
817-838-8342

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2227 HALTOM RD
Provider Second Line Business Practice Location Address:
SUITE G
Provider Business Practice Location Address City Name:
HALTOM CITY
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76117-5037
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-838-8940
Provider Business Practice Location Address Fax Number:
817-838-8342
Provider Enumeration Date:
08/29/2007

Additional Information

Authorized Official

Authorized Official Last Name:
PEREZ
Authorized Official First Name:
MIRIAM
Authorized Official Middle Name:
SULEMA
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
817-838-8940

Provider Taxonomy Codes

  • Taxonomy code: 332BX2000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 190781801 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 190781802 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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