Provider Demographics
NPI:1295134039
Name:MIDLAND DME, LLC
Entity type:Organization
Organization Name:MIDLAND DME, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:432-279-0786
Mailing Address - Street 1:1913 HERITAGE BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79707-9752
Mailing Address - Country:US
Mailing Address - Phone:432-279-0786
Mailing Address - Fax:
Practice Address - Street 1:1913 HERITAGE BLVD STE A
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79707-9752
Practice Address - Country:US
Practice Address - Phone:432-279-0786
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-18
Last Update Date:2014-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies