Provider Demographics
NPI:1215177068
Name:M D M HOME MEDICAL EQUIPMENT, LLC
Entity type:Organization
Organization Name:M D M HOME MEDICAL EQUIPMENT, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:DEWAYNE
Authorized Official - Last Name:ANDRUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:940-691-0551
Mailing Address - Street 1:PO BOX 4847
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76308-0847
Mailing Address - Country:US
Mailing Address - Phone:940-691-0551
Mailing Address - Fax:940-691-0757
Practice Address - Street 1:4084 REGENT DR
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76308-1508
Practice Address - Country:US
Practice Address - Phone:940-691-0551
Practice Address - Fax:940-691-0757
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-05
Last Update Date:2009-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies