Provider Demographics
NPI:1700103025
Name:SAINT MARIE MEDICAL SUPPLY LLC
Entity Type:Organization
Organization Name:SAINT MARIE MEDICAL SUPPLY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:BLAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-886-1411
Mailing Address - Street 1:4024 ELM ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75226-1232
Mailing Address - Country:US
Mailing Address - Phone:800-790-8416
Mailing Address - Fax:
Practice Address - Street 1:4024 ELM ST
Practice Address - Street 2:SUITE C
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75226-1232
Practice Address - Country:US
Practice Address - Phone:800-790-8416
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-26
Last Update Date:2011-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX6470510001Medicare NSC