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General NPI Number Information
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NPI Number | 1417726944
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Entity Type | Organization
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Legal Business Name | GEORGETOWN DME LLC
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Dates
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Enumeration Date | 12/26/2023
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Last Update Date | 04/05/2024
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Provider Practice Location Address
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Address Line | 110 NIGHTHAWK WAY
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City | GEORGETOWN
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State | TX
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Zip | 78633-4554
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Country | US
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Telephone | 800-854-0335
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Fax | 800-854-4155
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Provider Business Mailing Address
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Address Line | 110 NIGHTHAWK WAY
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City | GEORGETOWN
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State | TX
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Zip | 78633-4554
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Country | US
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Telephone | 800-854-0335
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Fax | 800-854-4155
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Authorized Official
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Title or Position | OWNER
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Name | JOHN MCKEOWN
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Credential |
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Telephone | 475-422-2207
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number |
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License Number State |
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