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General NPI Number Information
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NPI Number | 1053054999
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Entity Type | Organization
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Legal Business Name | GLC DME
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Dates
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Enumeration Date | 04/19/2022
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Last Update Date | 04/19/2022
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Provider Practice Location Address
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Address Line | 3254 BERKSHIRE RD NE
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City | RIO RANCHO
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State | NM
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Zip | 87144-1620
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Country | US
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Telephone | 505-391-9031
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Fax |
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Provider Business Mailing Address
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Address Line | 3254 BERKSHIRE RD NE
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City | RIO RANCHO
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State | NM
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Zip | 87144-1620
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Country | US
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Telephone | 505-391-9031
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Fax |
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Authorized Official
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Title or Position | OWNER/ REGISTERED RESPIRATORY THERA
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Name | DANIEL EDWARD HERRERA JR.
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Credential | RRT,RCP
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Telephone | 505-391-9031
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 332BX2000X
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Taxonomy Name | Oxygen Equipment & Supplies (DME)
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License Number |
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License Number State |
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