Provider Demographics
NPI:1558557579
Name:BRANDON'S DME SUPPLY LLC
Entity Type:Organization
Organization Name:BRANDON'S DME SUPPLY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:C
Authorized Official - Last Name:COBOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-225-4880
Mailing Address - Street 1:2716 N CONWAY AVE
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78574-2143
Mailing Address - Country:US
Mailing Address - Phone:956-432-0153
Mailing Address - Fax:956-432-0181
Practice Address - Street 1:2716 N CONWAY AVE
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78574-2143
Practice Address - Country:US
Practice Address - Phone:956-432-0153
Practice Address - Fax:956-432-0181
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-24
Last Update Date:2013-07-30
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
TX6039090001Medicare NSC