Provider Demographics
NPI:1407305881
Name:OAK DME SUPPLY COMPANY, LLC
Entity Type:Organization
Organization Name:OAK DME SUPPLY COMPANY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:D
Authorized Official - Last Name:CROMER
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:903-278-2474
Mailing Address - Street 1:6500 SUMMERHILL ROAD
Mailing Address - Street 2:SUITE C
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75503
Mailing Address - Country:US
Mailing Address - Phone:903-306-0908
Mailing Address - Fax:903-306-0925
Practice Address - Street 1:6500 SUMMERHILL RD STE C
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75503-1721
Practice Address - Country:US
Practice Address - Phone:903-306-0908
Practice Address - Fax:903-306-0925
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-27
Last Update Date:2018-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX380470001Medicaid
AR225317716Medicaid