Healthcare Provider Details

I. General information

NPI: 1790873289
Provider Name (Legal Business Name): M OLIVEIRA DME INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 09/28/2021
Certification Date: 09/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 E INTERSTATE 2 SUITE D
PHARR TX
78577-1720
US

IV. Provider business mailing address

105 E INTERSTATE 2 SUITE D
PHARR TX
78577-6562
US

V. Phone/Fax

Practice location:
  • Phone: 956-781-1713
  • Fax: 956-223-2651
Mailing address:
  • Phone: 956-781-1713
  • Fax: 956-223-2651

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number0012749
License Number StateTX

VIII. Authorized Official

Name: MR. CRAIG ALLEN
Title or Position: PRESIDENT/OWNER
Credential:
Phone: 956-618-2040