Provider Demographics
NPI:1205897659
Name:DURABLE MEDICAL EQUIPMENT, INC
Entity type:Organization
Organization Name:DURABLE MEDICAL EQUIPMENT, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:E
Authorized Official - Last Name:BECKHAM
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:706-846-2124
Mailing Address - Street 1:130 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:GA
Mailing Address - Zip Code:31816-1651
Mailing Address - Country:US
Mailing Address - Phone:706-846-2124
Mailing Address - Fax:706-846-8251
Practice Address - Street 1:130 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:GA
Practice Address - Zip Code:31816-1651
Practice Address - Country:US
Practice Address - Phone:706-846-2124
Practice Address - Fax:706-846-8251
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-28
Last Update Date:2014-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAC19509335E00000X
332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000453384BMedicaid
GA000453384BMedicaid
GA000453384BMedicaid
GA4264210004Medicare ID - Type UnspecifiedMEDICARE AFTER 3 21 07