=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316955693
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DURABLE ORTHOPAEDIC SUPPLIES, L.L.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/03/2006
-----------------------------------------------------
Last Update Date | 10/17/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3100 N LEE TREVINO DR STE 1000
-----------------------------------------------------
City | EL PASO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79936-2098
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 915-532-2228
-----------------------------------------------------
Fax | 915-532-2428
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 13725
-----------------------------------------------------
City | EL PASO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79913-3725
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 915-532-2228
-----------------------------------------------------
Fax | 915-532-2428
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MR. FRANK JOHN RICCI JR.
-----------------------------------------------------
Credential | RFO
-----------------------------------------------------
Telephone | 915-532-2228
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number | 0054358
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------