Provider Demographics
NPI:1063608529
Name:EXPRESS DURABLE MEDICAL EQUIPMENT,INC
Entity type:Organization
Organization Name:EXPRESS DURABLE MEDICAL EQUIPMENT,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:TREVINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-440-8100
Mailing Address - Street 1:512 VICTORIA LN
Mailing Address - Street 2:SUITE 10-B
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78550-3226
Mailing Address - Country:US
Mailing Address - Phone:956-440-8100
Mailing Address - Fax:956-440-8490
Practice Address - Street 1:512 VICTORIA LN STE 10B
Practice Address - Street 2:
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550-3230
Practice Address - Country:US
Practice Address - Phone:956-440-8100
Practice Address - Fax:956-440-8490
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-19
Last Update Date:2010-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX423098332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX6316770001Medicare NSC