Provider Demographics
NPI:1407231517
Name:GABLE RUNN DME LLC
Entity Type:Organization
Organization Name:GABLE RUNN DME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RODERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-436-9590
Mailing Address - Street 1:186 SEVEN FARMS DR
Mailing Address - Street 2:F110
Mailing Address - City:DANIEL ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29492-8510
Mailing Address - Country:US
Mailing Address - Phone:209-436-9590
Mailing Address - Fax:
Practice Address - Street 1:186 SEVEN FARMS DR
Practice Address - Street 2:F110
Practice Address - City:DANIEL ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29492-8510
Practice Address - Country:US
Practice Address - Phone:209-436-9590
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-30
Last Update Date:2015-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies