Provider Demographics
NPI:1114424835
Name:FAMILY DME SUPPLY LLC
Entity Type:Organization
Organization Name:FAMILY DME SUPPLY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:NKEM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-288-7337
Mailing Address - Street 1:4101 MCEWEN RD STE 513
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75244-5248
Mailing Address - Country:US
Mailing Address - Phone:469-288-7337
Mailing Address - Fax:
Practice Address - Street 1:4101 MCEWEN RD STE 513
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75244-5112
Practice Address - Country:US
Practice Address - Phone:469-288-7337
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-09
Last Update Date:2020-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDMEHS4918332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies