Provider Demographics
NPI:1497940035
Name:ISLAND DURABLE MEDICAL EQUIPMENT, LLC
Entity Type:Organization
Organization Name:ISLAND DURABLE MEDICAL EQUIPMENT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:RICHARDS
Authorized Official - Last Name:CARR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:361-749-0908
Mailing Address - Street 1:1908 STATE HWY 361
Mailing Address - Street 2:
Mailing Address - City:PORT ARANSAS
Mailing Address - State:TX
Mailing Address - Zip Code:78373-4894
Mailing Address - Country:US
Mailing Address - Phone:361-749-0908
Mailing Address - Fax:361-749-1120
Practice Address - Street 1:1908 STATE HWY 361
Practice Address - Street 2:
Practice Address - City:PORT ARANSAS
Practice Address - State:TX
Practice Address - Zip Code:78373-4894
Practice Address - Country:US
Practice Address - Phone:361-749-0908
Practice Address - Fax:361-749-1120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-06
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX6050250001Medicare NSC