Healthcare Provider Details

I. General information

NPI: 1114256492
Provider Name (Legal Business Name): REM DME, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2009
Last Update Date: 12/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12027 WHITMARSH LN
TAMPA FL
33626-1737
US

IV. Provider business mailing address

2895 HIGHWAY 190 SUITE 223
MANDEVILLE LA
70471-3414
US

V. Phone/Fax

Practice location:
  • Phone: 877-333-2575
  • Fax: 813-902-6509
Mailing address:
  • Phone: 985-727-0780
  • Fax: 985-727-0783

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS1200X
TaxonomySleep Disorder Diagnostic Clinic/Center
License NumberHCC8981
License Number StateFL

VIII. Authorized Official

Name: PAUL GREMILLION
Title or Position: CEO
Credential:
Phone: 985-727-0780