Provider Demographics
NPI:1508092800
Name:CLEARCHOICE DME LLC
Entity Type:Organization
Organization Name:CLEARCHOICE DME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:LYLE
Authorized Official - Middle Name:
Authorized Official - Last Name:NEWSOME
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-774-6500
Mailing Address - Street 1:544 E STUART DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:GALAX
Mailing Address - State:VA
Mailing Address - Zip Code:24333-2231
Mailing Address - Country:US
Mailing Address - Phone:276-238-0202
Mailing Address - Fax:276-238-1220
Practice Address - Street 1:544 E STUART DR
Practice Address - Street 2:SUITE C
Practice Address - City:GALAX
Practice Address - State:VA
Practice Address - Zip Code:24333-2231
Practice Address - Country:US
Practice Address - Phone:276-238-0202
Practice Address - Fax:276-238-1220
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TRIAD RESPIRATORY SOLUTION INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-06-02
Last Update Date:2010-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA001464332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA6266670001Medicare NSC