Provider Demographics
NPI:1396829354
Name:EXPRESS DME & SUPPLY, INC
Entity Type:Organization
Organization Name:EXPRESS DME & SUPPLY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:OMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:LEDEZMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-781-4004
Mailing Address - Street 1:802 E EXPRESSWAY 83
Mailing Address - Street 2:STE D
Mailing Address - City:PHARR
Mailing Address - State:TX
Mailing Address - Zip Code:78577-6524
Mailing Address - Country:US
Mailing Address - Phone:956-781-4004
Mailing Address - Fax:956-781-4304
Practice Address - Street 1:802 E EXPRESSWAY 83
Practice Address - Street 2:STE D
Practice Address - City:PHARR
Practice Address - State:TX
Practice Address - Zip Code:78577-6524
Practice Address - Country:US
Practice Address - Phone:956-781-4004
Practice Address - Fax:956-781-4304
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2012-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0087790332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX180374402Medicaid
TX180374401Medicaid
TX5654480001Medicare NSC