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General NPI Number Information
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NPI Number | 1447679618
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Entity Type | Organization
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Legal Business Name | SR DME HOLDINGS, LLC
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Dates
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Enumeration Date | 04/15/2014
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Last Update Date | 04/15/2014
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Provider Practice Location Address
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Address Line | 20639 KUYKENDAHL ROAD BUILDING A
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City | SPRING
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State | TX
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Zip | 77379-3376
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Country | US
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Telephone | 281-036-4112
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Fax | 281-210-2405
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Provider Business Mailing Address
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Address Line | PO BOX 4346
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City | HOUSTON
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State | TX
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Zip | 77210-4346
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Country | US
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Telephone | 281-364-1122
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Fax | 281-210-2405
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. WILLIAM MICHAEL HAYES
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Credential | M.D.
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Telephone | 281-798-3172
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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 | 1001252
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License Number State | TX
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