Provider Demographics
NPI:1316955693
Name:DURABLE ORTHOPAEDIC SUPPLIES, L.L.C.
Entity type:Organization
Organization Name:DURABLE ORTHOPAEDIC SUPPLIES, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:RICCI
Authorized Official - Suffix:JR
Authorized Official - Credentials:RFO
Authorized Official - Phone:915-532-2228
Mailing Address - Street 1:PO BOX 13725
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79913-3725
Mailing Address - Country:US
Mailing Address - Phone:915-532-2228
Mailing Address - Fax:915-532-2428
Practice Address - Street 1:3100 N LEE TREVINO DR STE 1000
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-2098
Practice Address - Country:US
Practice Address - Phone:915-532-2228
Practice Address - Fax:915-532-2428
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-03
Last Update Date:2018-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0054358332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1151530001OtherPTAN
TX519920OtherBLUE CROSS BLUE SHIELD TX
TX0164659-01Medicaid
TX0105819-01Medicaid