MEDICARE: FAMILY DME SUPPLY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies	DMEHS4918	TX

General Provider Information

NPI Number	:	1114424835
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY DME SUPPLY LLC

Provider Business Mailing Address
First Line	:	4101 MCEWEN RD STE 513
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75244-5248
Country	:	US
Telephone Number	:	469-288-7337
Fax Number	:

Provider Business Practice Location Address
First Line	:	4101 MCEWEN RD STE 513
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75244-5112
Country	:	US
Telephone Number	:	469-288-7337
Fax Number	:

Authorized Official
Title or Position	:	MANAGING DIRECTOR
Name	:	MR. MICHAEL NKEM
Credential	:
Telephone Number	:	469-288-7337

Provider Enumeration Date	:	04/09/2018
Last Update Date	:	05/25/2020

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Directions to “FAMILY DME SUPPLY LLC ” Practice Location

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