MEDICARE: DME AUTHORITY, 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	332BC3200X	Customized Equipment (DME)

General Provider Information

NPI Number	:	1639804909
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DME AUTHORITY, LLC

Provider Business Mailing Address
First Line	:	607 HERITAGE DR
Second Line	:
City	:	MOUNT JULIET
State	:	TN
Zip	:	37122-8542
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	607 HERITAGE DR
Second Line	:
City	:	MOUNT JULIET
State	:	TN
Zip	:	37122-8542
Country	:	US
Telephone Number	:	214-608-5008
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	ERICK GOSSE
Credential	:
Telephone Number	:	214-608-5008

Provider Enumeration Date	:	07/20/2022
Last Update Date	:	07/20/2022

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Directions to “DME AUTHORITY, LLC ” Practice Location

Language	Start Address	Practice Location

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