Provider Demographics
NPI:1982847992
Name:ALLSTATE DME, LLC
Entity Type:Organization
Organization Name:ALLSTATE DME, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ARANGO
Authorized Official - Middle Name:
Authorized Official - Last Name:JORGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-627-3767
Mailing Address - Street 1:1103 N RAUL LONGORIA RD STE C
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:TX
Mailing Address - Zip Code:78589-3600
Mailing Address - Country:US
Mailing Address - Phone:956-627-3767
Mailing Address - Fax:956-627-3776
Practice Address - Street 1:1103 N RAUL LONGORIA RD STE C
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:TX
Practice Address - Zip Code:78589-3600
Practice Address - Country:US
Practice Address - Phone:956-627-3767
Practice Address - Fax:956-627-3776
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-07
Last Update Date:2015-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0109608332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0109608OtherTEXAS STATE LICENSE
TX6385310001Medicare NSC