Provider Demographics
NPI:1801669254
Name:CITY DURABLE MEDICAL EQUIPMENT SUPPLY LLC
Entity type:Organization
Organization Name:CITY DURABLE MEDICAL EQUIPMENT SUPPLY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BENSON
Authorized Official - Middle Name:OTA
Authorized Official - Last Name:OSAGIEDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-876-4705
Mailing Address - Street 1:310 E INTERSTATE 30 STE B111
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75043-8000
Mailing Address - Country:US
Mailing Address - Phone:214-258-5822
Mailing Address - Fax:
Practice Address - Street 1:310 E INTERSTATE 30 STE B111
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75043-8000
Practice Address - Country:US
Practice Address - Phone:214-258-5822
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-06
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies