Provider Demographics
NPI:1891748166
Name:DIRECT MEDICAL EQUIPMENT, INC
Entity Type:Organization
Organization Name:DIRECT MEDICAL EQUIPMENT, INC
Other - Org Name:ONE SOURCE MEDICAL SUPPLY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:LICA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-581-4141
Mailing Address - Street 1:3300 SW 46TH AVE
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33314-2215
Mailing Address - Country:US
Mailing Address - Phone:954-581-4141
Mailing Address - Fax:954-797-2633
Practice Address - Street 1:CARR. 189 KM 3.1
Practice Address - Street 2:BO. RINCON
Practice Address - City:GURABO
Practice Address - State:PR
Practice Address - Zip Code:00778
Practice Address - Country:US
Practice Address - Phone:787-703-2450
Practice Address - Fax:787-703-2420
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Not Answered332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Not Answered332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1260580001Medicare ID - Type Unspecified