Provider Demographics
NPI:1700085354
Name:DURAMEDICAL
Entity Type:Organization
Organization Name:DURAMEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:MAYDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-745-7500
Mailing Address - Street 1:PO BOX 126261
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76126-0261
Mailing Address - Country:US
Mailing Address - Phone:972-745-7500
Mailing Address - Fax:972-471-0700
Practice Address - Street 1:601 CANYON DR
Practice Address - Street 2:SUITE 100
Practice Address - City:COPPELL
Practice Address - State:TX
Practice Address - Zip Code:75019-3859
Practice Address - Country:US
Practice Address - Phone:972-745-7500
Practice Address - Fax:972-471-0700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-13
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies