Healthcare Provider Details

I. General information

NPI: 1447679618
Provider Name (Legal Business Name): SR DME HOLDINGS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2014
Last Update Date: 04/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20639 KUYKENDAHL ROAD BUILDING A
SPRING TX
77379-3376
US

IV. Provider business mailing address

PO BOX 4346
HOUSTON TX
77210-4346
US

V. Phone/Fax

Practice location:
  • Phone: 281-036-4112
  • Fax: 281-210-2405
Mailing address:
  • Phone: 281-364-1122
  • Fax: 281-210-2405

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number1001252
License Number StateTX

VIII. Authorized Official

Name: MR. WILLIAM MICHAEL HAYES
Title or Position: PRESIDENT
Credential: M.D.
Phone: 281-798-3172