Provider Demographics
NPI:1174793558
Name:CAPROCK DME MEDICAL SUPPLY, INC
Entity type:Organization
Organization Name:CAPROCK DME MEDICAL SUPPLY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARCIANO
Authorized Official - Middle Name:
Authorized Official - Last Name:MORALES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-791-0077
Mailing Address - Street 1:3411 KNOXVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79413-2215
Mailing Address - Country:US
Mailing Address - Phone:806-784-4561
Mailing Address - Fax:
Practice Address - Street 1:3407 34TH ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79410-2829
Practice Address - Country:US
Practice Address - Phone:806-791-1599
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CAPROCK DME MEDICAL SUPPLY, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-03-03
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies