Provider Demographics
NPI:1689774754
Name:CLC DURABLE MEDICAL EQUIPMENT
Entity Type:Organization
Organization Name:CLC DURABLE MEDICAL EQUIPMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANGE;A
Authorized Official - Middle Name:G
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-462-0437
Mailing Address - Street 1:303 DREAMLAND AVE
Mailing Address - Street 2:
Mailing Address - City:CROSBY
Mailing Address - State:TX
Mailing Address - Zip Code:77532-2647
Mailing Address - Country:US
Mailing Address - Phone:281-462-0437
Mailing Address - Fax:281-462-0493
Practice Address - Street 1:303 DREAMLAND AVE
Practice Address - Street 2:
Practice Address - City:CROSBY
Practice Address - State:TX
Practice Address - Zip Code:77532-2647
Practice Address - Country:US
Practice Address - Phone:281-462-0437
Practice Address - Fax:281-462-0493
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
TX332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies