MEDICARE: NIC DME, INC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	332BP3500X	Parenteral & Enteral Nutrition Supplies (DME)
2	332BX2000X	Oxygen Equipment & Supplies (DME)
3	335E00000X	Prosthetic/Orthotic Supplier
4	332B00000X	Durable Medical Equipment & Medical Supplies

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	531609	OTHER	TX	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1710070891
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NIC DME, INC

Provider Business Mailing Address
First Line	:	3120 CENTER POINT DR
Second Line	:
City	:	EDINBURG
State	:	TX
Zip	:	78539-4804
Country	:	US
Telephone Number	:	956-994-9424
Fax Number	:	956-994-9828

Provider Business Practice Location Address
First Line	:	3120 CENTER POINT DR
Second Line	:
City	:	EDINBURG
State	:	TX
Zip	:	78539-4804
Country	:	US
Telephone Number	:	956-994-9424
Fax Number	:	956-994-9828

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	SHARON POOLE
Credential	:
Telephone Number	:	956-994-9424

Provider Enumeration Date	:	10/02/2006
Last Update Date	:	07/19/2007

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Directions to “NIC DME, INC ” Practice Location

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