Provider Demographics
NPI:1669794467
Name:O2 DME DURABLE EQUIPMENT & SUPPLY LLC
Entity type:Organization
Organization Name:O2 DME DURABLE EQUIPMENT & SUPPLY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARIVEL
Authorized Official - Middle Name:
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-263-1630
Mailing Address - Street 1:103 S KAIN ST UNIT 1
Mailing Address - Street 2:
Mailing Address - City:RIO GRANDE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:78582-4221
Mailing Address - Country:US
Mailing Address - Phone:956-263-1630
Mailing Address - Fax:956-263-1602
Practice Address - Street 1:103 KAIN ST UNIT 1
Practice Address - Street 2:
Practice Address - City:RIO GRANDE CITY
Practice Address - State:TX
Practice Address - Zip Code:78582-6667
Practice Address - Country:US
Practice Address - Phone:956-263-1630
Practice Address - Fax:956-263-1602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-19
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX332BP3500X, 332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX214149101Medicaid
TX214149102Medicaid
TX6408220001Medicare NSC