Provider Demographics
NPI:1942752308
Name:DORSEY DIRECT DME
Entity Type:Organization
Organization Name:DORSEY DIRECT DME
Other - Org Name:HOME DIRECT DME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:VEGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-352-7237
Mailing Address - Street 1:7507 CLOS DU BOIS
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78253-4888
Mailing Address - Country:US
Mailing Address - Phone:719-352-7237
Mailing Address - Fax:
Practice Address - Street 1:7507 CLOS DU BOIS
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78253-4888
Practice Address - Country:US
Practice Address - Phone:719-352-7237
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-01
Last Update Date:2016-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies