Provider Demographics
NPI:1598700874
Name:PLATINUM DME, LLC
Entity Type:Organization
Organization Name:PLATINUM DME, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:N
Authorized Official - Last Name:DIMSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-213-3952
Mailing Address - Street 1:10449 E CLOVER LN
Mailing Address - Street 2:
Mailing Address - City:FORNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75126-7915
Mailing Address - Country:US
Mailing Address - Phone:972-564-6511
Mailing Address - Fax:
Practice Address - Street 1:9330 AMBERTON PKWY
Practice Address - Street 2:STE. 1220
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-3278
Practice Address - Country:US
Practice Address - Phone:214-389-1907
Practice Address - Fax:214-389-1908
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0086488332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX5733340001Medicare ID - Type Unspecified