MEDICARE: CRYSTAL DME

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

General Provider Information

NPI Number	:	1538314554
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CRYSTAL DME

Provider Business Mailing Address
First Line	:	433 W 12TH ST
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75208-6507
Country	:	US
Telephone Number	:	214-206-6970
Fax Number	:	214-946-6923

Provider Business Practice Location Address
First Line	:	433 W 12TH ST
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75208-6507
Country	:	US
Telephone Number	:	214-206-6970
Fax Number	:	214-946-6923

Authorized Official
Title or Position	:	OWNER
Name	:	OLIVIA LOCASCIO
Credential	:
Telephone Number	:	214-943-7799

Provider Enumeration Date	:	11/18/2008
Last Update Date	:	03/23/2009

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Directions to “CRYSTAL DME ” Practice Location

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