MEDICARE: TEXAS D.M.E., INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332BC3200X	Customized Equipment (DME)
2	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1235210717
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TEXAS D.M.E., INC.

Provider Business Mailing Address
First Line	:	604 N NOLAN RIVER RD
Second Line	:
City	:	CLEBURNE
State	:	TX
Zip	:	76033-7008
Country	:	US
Telephone Number	:	817-645-4718
Fax Number	:	817-641-2960

Provider Business Practice Location Address
First Line	:	1516 PENNSYLVANIA AVE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76104-2027
Country	:	US
Telephone Number	:	817-332-4235
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	THOMAS HAFFORD
Credential	:	ATS
Telephone Number	:	817-645-4718

Provider Enumeration Date	:	10/18/2006
Last Update Date	:	03/18/2008

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