Provider Demographics
NPI:1740561638
Name:DME DIRECT LLC
Entity Type:Organization
Organization Name:DME DIRECT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RANDELL
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:FARLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-593-4000
Mailing Address - Street 1:4204 GARDENDALE ST STE 107
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3138
Mailing Address - Country:US
Mailing Address - Phone:210-593-4000
Mailing Address - Fax:210-593-4003
Practice Address - Street 1:4204 GARDENDALE ST STE 107
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3138
Practice Address - Country:US
Practice Address - Phone:210-593-4000
Practice Address - Fax:210-593-4003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-06
Last Update Date:2011-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies