Provider Demographics
NPI:1508973967
Name:CAPROCK DME AND MEDICAL SUPPLY, INC.
Entity Type:Organization
Organization Name:CAPROCK DME AND MEDICAL SUPPLY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/C.E.O.
Authorized Official - Prefix:MR
Authorized Official - First Name:MARCIANO
Authorized Official - Middle Name:
Authorized Official - Last Name:MORALES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-791-0077
Mailing Address - Street 1:8806 UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79423-3152
Mailing Address - Country:US
Mailing Address - Phone:806-791-0077
Mailing Address - Fax:806-748-7837
Practice Address - Street 1:8806 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79423-3152
Practice Address - Country:US
Practice Address - Phone:806-791-0077
Practice Address - Fax:806-748-7837
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-23
Last Update Date:2009-09-30
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
TX5848420001Medicare NSC