=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427606946
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DURABILL
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/28/2019
-----------------------------------------------------
Last Update Date | 08/28/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 906 W MCDERMOTT DR. STE 116
-----------------------------------------------------
City | ALLEN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75013-5426
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-435-8599
-----------------------------------------------------
Fax | 214-602-7075
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4000 MOONLIGHT DR
-----------------------------------------------------
City | LITTLE ELM
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75068-3127
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-435-8599
-----------------------------------------------------
Fax | 214-602-7075
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VICE PRESIDENT
-----------------------------------------------------
Name | ALBERT FRANCIS BRUNELLE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 214-435-8599
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------