Provider Demographics
NPI:1982840120
Name:MIRIAM'S DME, LLC
Entity Type:Organization
Organization Name:MIRIAM'S DME, LLC
Other - Org Name:LILLIAN'S DME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:C
Authorized Official - Last Name:ROSALES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-440-1600
Mailing Address - Street 1:2112 W UNIVERSITY DR
Mailing Address - Street 2:P.M.B 1251
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539-2862
Mailing Address - Country:US
Mailing Address - Phone:956-440-1600
Mailing Address - Fax:956-440-1603
Practice Address - Street 1:2323 N ED CAREY DR
Practice Address - Street 2:SUITE 7
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550-8231
Practice Address - Country:US
Practice Address - Phone:956-440-1600
Practice Address - Fax:956-440-1603
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-17
Last Update Date:2009-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX203340902Medicaid
TX203340901Medicaid
TX203340902Medicaid