Provider Demographics
NPI:1720047095
Name:DURABLE MEDICAL EQUIPMENT, INC
Entity Type:Organization
Organization Name:DURABLE MEDICAL EQUIPMENT, INC
Other - Org Name:LAGRANGE HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:E
Authorized Official - Last Name:BECKHAM
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:706-882-2661
Mailing Address - Street 1:100 MOOTY BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:LAGRANGE
Mailing Address - State:GA
Mailing Address - Zip Code:30240-1806
Mailing Address - Country:US
Mailing Address - Phone:706-882-2661
Mailing Address - Fax:706-882-2251
Practice Address - Street 1:100 MOOTY BRIDGE RD
Practice Address - Street 2:
Practice Address - City:LAGRANGE
Practice Address - State:GA
Practice Address - Zip Code:30240-1806
Practice Address - Country:US
Practice Address - Phone:706-882-2661
Practice Address - Fax:706-882-2251
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-23
Last Update Date:2009-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA332B00000X
332BX2000X
C19509335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000924074AMedicaid
GA000924074AMedicaid
GA4264210001Medicare ID - Type Unspecified