Healthcare Provider Details

I. General information

NPI: 1720047095
Provider Name (Legal Business Name): DURABLE MEDICAL EQUIPMENT, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2006
Last Update Date: 10/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MOOTY BRIDGE RD
LAGRANGE GA
30240-1806
US

IV. Provider business mailing address

100 MOOTY BRIDGE RD
LAGRANGE GA
30240-1806
US

V. Phone/Fax

Practice location:
  • Phone: 706-882-2661
  • Fax: 706-882-2251
Mailing address:
  • Phone: 706-882-2661
  • Fax: 706-882-2251

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License NumberC19509
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: THOMAS E BECKHAM
Title or Position: EXECUTIVE VICE PRESIDENT
Credential: R.PH.
Phone: 706-882-2661