Provider Demographics
NPI:1417149287
Name:ROADRUNNER DME CORPORATION
Entity Type:Organization
Organization Name:ROADRUNNER DME CORPORATION
Other - Org Name:ROADRUNNER DME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RICARDO
Authorized Official - Middle Name:
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-783-7155
Mailing Address - Street 1:715 E FRONTAGE
Mailing Address - Street 2:SUITE C
Mailing Address - City:ALAMO
Mailing Address - State:TX
Mailing Address - Zip Code:78516
Mailing Address - Country:US
Mailing Address - Phone:956-783-7155
Mailing Address - Fax:956-783-7160
Practice Address - Street 1:715 E FRONTAGE
Practice Address - Street 2:SUITE C
Practice Address - City:ALAMO
Practice Address - State:TX
Practice Address - Zip Code:78516-2322
Practice Address - Country:US
Practice Address - Phone:956-783-7155
Practice Address - Fax:956-783-7160
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-15
Last Update Date:2018-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0097246332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX189752202Medicaid
TX0097246OtherLICENSE
TX189752201Medicaid
TX0097246OtherLICENSE