Healthcare Provider Details

I. General information

NPI: 1245237643
Provider Name (Legal Business Name): DURA MEDIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3601 S CONGRESS AVE STE B-400B
AUSTIN TX
78704
US

IV. Provider business mailing address

PO BOX 2728
AUSTIN TX
78768-2728
US

V. Phone/Fax

Practice location:
  • Phone: 512-320-5400
  • Fax: 512-320-9961
Mailing address:
  • Phone: 512-320-5400
  • Fax: 512-320-9961

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateTX

VIII. Authorized Official

Name: MR. TIM TIDD
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 512-320-5400