Provider Demographics
NPI:1922292325
Name:LONE STAR DME SUPPLY LLC
Entity Type:Organization
Organization Name:LONE STAR DME SUPPLY LLC
Other - Org Name:LONE STAR MEDICAL SUPPLY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MIRIAM
Authorized Official - Middle Name:SULEMA
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-838-8940
Mailing Address - Street 1:2227 HALTOM RD
Mailing Address - Street 2:SUITE G
Mailing Address - City:HALTOM CITY
Mailing Address - State:TX
Mailing Address - Zip Code:76117-5037
Mailing Address - Country:US
Mailing Address - Phone:817-838-8940
Mailing Address - Fax:817-838-8342
Practice Address - Street 1:2227 HALTOM RD
Practice Address - Street 2:SUITE G
Practice Address - City:HALTOM CITY
Practice Address - State:TX
Practice Address - Zip Code:76117-5037
Practice Address - Country:US
Practice Address - Phone:817-838-8940
Practice Address - Fax:817-838-8342
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-29
Last Update Date:2008-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX190781801Medicaid
TX190781802Medicaid
TX6025570001Medicare NSC