=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588859086
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MONTANA'S DURABLE MEDICAL EQUIPMENT
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/09/2007
-----------------------------------------------------
Last Update Date | 09/09/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2935 SOUTHMOST RD STE B
-----------------------------------------------------
City | BROWNSVILLE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78521-4772
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-574-0737
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 884 PINE MORE DR
-----------------------------------------------------
City | BROWNSVILLE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78526-4276
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-465-8718
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIFE EXECUTIVE OFFICER
-----------------------------------------------------
Name | MR. ELVA URIBE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 956-465-8718
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332BX2000X
-----------------------------------------------------
Taxonomy Name | Oxygen Equipment & Supplies (DME)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------