Provider Demographics
NPI:1053054999
Name:GLC DME
Entity Type:Organization
Organization Name:GLC DME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ REGISTERED RESPIRATORY THERA
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:HERRERA
Authorized Official - Suffix:JR
Authorized Official - Credentials:RRT,RCP
Authorized Official - Phone:505-391-9031
Mailing Address - Street 1:3254 BERKSHIRE RD NE
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87144-1620
Mailing Address - Country:US
Mailing Address - Phone:505-391-9031
Mailing Address - Fax:
Practice Address - Street 1:3254 BERKSHIRE RD NE
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87144-1620
Practice Address - Country:US
Practice Address - Phone:505-391-9031
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-19
Last Update Date:2022-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)