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General NPI Number Information
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NPI Number | 1508104274
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Entity Type | Organization
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Legal Business Name | REPUBLIC DURABLE MEDICAL EQUIPMENT, LLC
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Dates
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Enumeration Date | 01/30/2013
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Last Update Date | 01/30/2013
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Provider Practice Location Address
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Address Line | 13201 NORTHWEST FWY SUITE 703
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City | HOUSTON
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State | TX
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Zip | 77040-6008
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Country | US
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Telephone | 469-343-8286
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Fax |
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Provider Business Mailing Address
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Address Line | 13201 NORTHWEST FWY SUITE 703
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City | HOUSTON
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State | TX
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Zip | 77040-6008
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/MANAGING MEMBER
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Name | MISS LINDSEY MICHELLE GENGO
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Credential |
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Telephone | 469-343-8286
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 1001063
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License Number State | TX
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