Provider Demographics
NPI:1336155175
Name:PERFORMANCE DME AND MEDICAL SUPPLY, ALLIANCE DME AND MEDICAL
Entity Type:Organization
Organization Name:PERFORMANCE DME AND MEDICAL SUPPLY, ALLIANCE DME AND MEDICAL
Other - Org Name:ALLIANCE DME AND MEDICAL SUPPLY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT,OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:DALE
Authorized Official - Last Name:BUCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-357-5913
Mailing Address - Street 1:2445 MIDWAY RD
Mailing Address - Street 2:SUITE # 103
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75006-2555
Mailing Address - Country:US
Mailing Address - Phone:214-357-5913
Mailing Address - Fax:214-357-8204
Practice Address - Street 1:2445 MIDWAY RD
Practice Address - Street 2:SUITE # 103
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75006-2555
Practice Address - Country:US
Practice Address - Phone:214-357-5913
Practice Address - Fax:214-357-8204
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-01
Last Update Date:2009-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0088008332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0088008OtherSTATE LICENSE
TX5819400001Medicare NSC