Provider Demographics
NPI:1760439897
Name:TEXAS DME INC
Entity Type:Organization
Organization Name:TEXAS DME INC
Other - Org Name:MOBILITY DYNAMICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TYRONE
Authorized Official - Middle Name:D
Authorized Official - Last Name:YULE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-645-4718
Mailing Address - Street 1:604 N NOLAN RIVER RD
Mailing Address - Street 2:
Mailing Address - City:CLEBURNE
Mailing Address - State:TX
Mailing Address - Zip Code:76033-7008
Mailing Address - Country:US
Mailing Address - Phone:817-645-4718
Mailing Address - Fax:817-641-2960
Practice Address - Street 1:604 N NOLAN RIVER RD
Practice Address - Street 2:
Practice Address - City:CLEBURNE
Practice Address - State:TX
Practice Address - Zip Code:76033-7008
Practice Address - Country:US
Practice Address - Phone:817-645-4718
Practice Address - Fax:817-641-2960
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-27
Last Update Date:2015-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX015900601Medicaid
TX087080001Medicaid
TX0167820001Medicare NSC