Provider Demographics
NPI:1699770115
Name:DURABLE MEDICAL EQUIPMENT, INC.
Entity type:Organization
Organization Name:DURABLE MEDICAL EQUIPMENT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:BRADSHAW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-454-8663
Mailing Address - Street 1:3900 MEDICAL PKWY
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78756-4004
Mailing Address - Country:US
Mailing Address - Phone:512-454-8663
Mailing Address - Fax:512-454-8665
Practice Address - Street 1:3900 MEDICAL PKWY
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78756-4004
Practice Address - Country:US
Practice Address - Phone:512-454-8663
Practice Address - Fax:512-454-8665
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-21
Last Update Date:2012-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX015508701Medicaid
TX086298901Medicaid
TX0422010001Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
TXC08445607Medicare ID - Type UnspecifiedMEDICARE ELECTRONIC NUMBE