Provider Demographics
NPI:1588316269
Name:GODSPEED DME, LLC
Entity type:Organization
Organization Name:GODSPEED DME, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:NAKALA
Authorized Official - Middle Name:RANELLE
Authorized Official - Last Name:DELARUE
Authorized Official - Suffix:
Authorized Official - Credentials:RCP
Authorized Official - Phone:409-791-0087
Mailing Address - Street 1:205 GREENTREE ST
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:TX
Mailing Address - Zip Code:77657-5903
Mailing Address - Country:US
Mailing Address - Phone:409-791-0087
Mailing Address - Fax:
Practice Address - Street 1:1503 S MARGARET AVE
Practice Address - Street 2:UNIT 1 & 2
Practice Address - City:KIRBYVILLE
Practice Address - State:TX
Practice Address - Zip Code:75956-2615
Practice Address - Country:US
Practice Address - Phone:409-791-0087
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-24
Last Update Date:2023-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies