Healthcare Provider Details

I. General information

NPI: 1104982560
Provider Name (Legal Business Name): DURA MED, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2006
Last Update Date: 02/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 BESSEMER AVE
LLANO TX
78643-1608
US

IV. Provider business mailing address

600 BESSEMER AVE
LLANO TX
78643-1608
US

V. Phone/Fax

Practice location:
  • Phone: 325-247-4155
  • Fax: 325-247-5554
Mailing address:
  • Phone: 325-247-4155
  • Fax: 325-247-5554

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number0083377
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number0083377
License Number StateTX

VIII. Authorized Official

Name: CRESTA TATE
Title or Position: MANAGER
Credential:
Phone: 512-756-8550