Provider Demographics
NPI:1417726944
Name:GEORGETOWN DME LLC
Entity Type:Organization
Organization Name:GEORGETOWN DME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCKEOWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:475-422-2207
Mailing Address - Street 1:110 NIGHTHAWK WAY
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78633-4554
Mailing Address - Country:US
Mailing Address - Phone:800-854-0335
Mailing Address - Fax:800-854-4155
Practice Address - Street 1:110 NIGHTHAWK WAY
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78633-4554
Practice Address - Country:US
Practice Address - Phone:800-854-0335
Practice Address - Fax:800-854-4155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-26
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment