Provider Demographics
NPI:1558360008
Name:AMERICAN DURABLE MEDICAL EQUIPMENT CORPORATION
Entity Type:Organization
Organization Name:AMERICAN DURABLE MEDICAL EQUIPMENT CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:WING
Authorized Official - Middle Name:H
Authorized Official - Last Name:CHUN
Authorized Official - Suffix:
Authorized Official - Credentials:RN, MSN
Authorized Official - Phone:972-818-2828
Mailing Address - Street 1:1177 ROCKINGHAM DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-4372
Mailing Address - Country:US
Mailing Address - Phone:972-818-2828
Mailing Address - Fax:972-818-9489
Practice Address - Street 1:1177 ROCKINGHAM DR
Practice Address - Street 2:SUITE 200
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-4372
Practice Address - Country:US
Practice Address - Phone:972-818-2828
Practice Address - Fax:972-818-9489
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-18
Last Update Date:2014-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0076746332B00000X, 332BP3500X, 332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX154458701Medicaid
TX154458701Medicaid