Provider Demographics
NPI:1235625641
Name:DURA MEDIC, LLC
Entity Type:Organization
Organization Name:DURA MEDIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:TIM
Authorized Official - Middle Name:
Authorized Official - Last Name:TIDD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-320-5400
Mailing Address - Street 1:PO BOX 2728
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78768-2728
Mailing Address - Country:US
Mailing Address - Phone:512-320-5400
Mailing Address - Fax:
Practice Address - Street 1:8044 SUMMA AVE # B-2
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-3411
Practice Address - Country:US
Practice Address - Phone:512-320-5400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DURA MEDIC, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-07-09
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies