Healthcare Provider Details

I. General information

NPI: 1053054999
Provider Name (Legal Business Name): GLC DME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2022
Last Update Date: 04/19/2022
Certification Date: 04/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3254 BERKSHIRE RD NE
RIO RANCHO NM
87144-1620
US

IV. Provider business mailing address

3254 BERKSHIRE RD NE
RIO RANCHO NM
87144-1620
US

V. Phone/Fax

Practice location:
  • Phone: 505-391-9031
  • Fax:
Mailing address:
  • Phone: 505-391-9031
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: DANIEL EDWARD HERRERA JR.
Title or Position: OWNER/ REGISTERED RESPIRATORY THERA
Credential: RRT,RCP
Phone: 505-391-9031