Provider Demographics
NPI:1366066946
Name:SELECT DME LLC
Entity type:Organization
Organization Name:SELECT DME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MATT
Authorized Official - Middle Name:
Authorized Official - Last Name:DYNES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-382-2515
Mailing Address - Street 1:6805 NE LOOP 820 STE 412
Mailing Address - Street 2:
Mailing Address - City:NORTH RICHLAND HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:76180-6687
Mailing Address - Country:US
Mailing Address - Phone:817-382-2515
Mailing Address - Fax:817-887-5767
Practice Address - Street 1:6805 NE LOOP 820 STE 412
Practice Address - Street 2:
Practice Address - City:NORTH RICHLAND HILLS
Practice Address - State:TX
Practice Address - Zip Code:76180-6687
Practice Address - Country:US
Practice Address - Phone:817-382-2515
Practice Address - Fax:817-887-5767
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-30
Last Update Date:2020-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies