MEDICARE: O2 DME DURABLE EQUIPMENT & 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	332BP3500X	Parenteral & Enteral Nutrition Supplies (DME)		TX
2	332BX2000X	Oxygen Equipment & Supplies (DME)		TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1669794467
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	O2 DME DURABLE EQUIPMENT & SUPPLY LLC

Provider Business Mailing Address
First Line	:	103 S KAIN ST UNIT 1
Second Line	:
City	:	RIO GRANDE CITY
State	:	TX
Zip	:	78582-4221
Country	:	US
Telephone Number	:	956-263-1630
Fax Number	:	956-263-1602

Provider Business Practice Location Address
First Line	:	103 KAIN ST UNIT 1
Second Line	:
City	:	RIO GRANDE CITY
State	:	TX
Zip	:	78582-6667
Country	:	US
Telephone Number	:	956-263-1630
Fax Number	:	956-263-1602

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MARIVEL PEREZ
Credential	:
Telephone Number	:	956-263-1630

Provider Enumeration Date	:	02/19/2010
Last Update Date	:	01/12/2012

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