Healthcare Provider Details

I. General information

NPI: 1437216942
Provider Name (Legal Business Name): DDMEDICAL SUPPLIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2007
Last Update Date: 03/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12115 SELF PLAZA DR
DALLAS TX
75218-1469
US

IV. Provider business mailing address

12115 SELF PLAZA DR
DALLAS TX
75218-1469
US

V. Phone/Fax

Practice location:
  • Phone: 469-774-3750
  • Fax:
Mailing address:
  • Phone: 972-329-4800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number0030615
License Number StateTX

VIII. Authorized Official

Name: TOM VARUGHESE
Title or Position: CEO
Credential:
Phone: 972-329-4800