Provider Demographics
NPI:1023274958
Name:DME MEDICAL SUPPLY DEPOT, LLC
Entity type:Organization
Organization Name:DME MEDICAL SUPPLY DEPOT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:EVERARDO
Authorized Official - Middle Name:
Authorized Official - Last Name:VILLARREAL
Authorized Official - Suffix:
Authorized Official - Credentials:PTA
Authorized Official - Phone:956-720-4120
Mailing Address - Street 1:13600 E HIGHWAY 107
Mailing Address - Street 2:SUITE 5
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78542-1644
Mailing Address - Country:US
Mailing Address - Phone:956-720-4120
Mailing Address - Fax:956-720-4042
Practice Address - Street 1:13600 E HIGHWAY 107
Practice Address - Street 2:SUITE 5
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78542-1644
Practice Address - Country:US
Practice Address - Phone:956-720-4120
Practice Address - Fax:956-720-4042
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-30
Last Update Date:2009-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0105698332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX6180760001Medicare NSC