Provider Demographics
NPI:1528452646
Name:HARBOR MEDICAL EQUIPMENT, LLC
Entity type:Organization
Organization Name:HARBOR MEDICAL EQUIPMENT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:SHOCKLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-326-3244
Mailing Address - Street 1:2101 E SAINT ELMO RD BLDG 2
Mailing Address - Street 2:SUITE 275
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78744-1863
Mailing Address - Country:US
Mailing Address - Phone:512-326-3244
Mailing Address - Fax:512-326-3299
Practice Address - Street 1:2101 E SAINT ELMO RD BLDG 2
Practice Address - Street 2:SUITE 275
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78744-1863
Practice Address - Country:US
Practice Address - Phone:512-326-3244
Practice Address - Fax:512-326-3299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-26
Last Update Date:2015-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1001512332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX7387210001Medicare PIN
TX1528452646Medicare UPIN