MEDICARE: MEDESSENTIALS DME SERVICES, LLC

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	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1326350687
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDESSENTIALS DME SERVICES, LLC

Provider Business Mailing Address
First Line	:	PO BOX 291480
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79929-1480
Country	:	US
Telephone Number	:	915-490-5373
Fax Number	:	915-975-8318

Provider Business Practice Location Address
First Line	:	9917 MOSES DR
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79927-2926
Country	:	US
Telephone Number	:	915-490-5373
Fax Number	:	915-975-8318

Authorized Official
Title or Position	:	PRESIDENT
Name	:	CLARISA LOPEZ
Credential	:
Telephone Number	:	915-490-5373

Provider Enumeration Date	:	07/01/2010
Last Update Date	:	07/01/2010

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