MEDICARE: DME DIRECT 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

General Provider Information

NPI Number	:	1740561638
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DME DIRECT LLC

Provider Business Mailing Address
First Line	:	4204 GARDENDALE ST STE 107
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78229-3138
Country	:	US
Telephone Number	:	210-593-4000
Fax Number	:	210-593-4003

Provider Business Practice Location Address
First Line	:	4204 GARDENDALE ST STE 107
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78229-3138
Country	:	US
Telephone Number	:	210-593-4000
Fax Number	:	210-593-4003

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. RANDELL SCOTT FARLEY
Credential	:
Telephone Number	:	210-593-4000

Provider Enumeration Date	:	09/06/2011
Last Update Date	:	09/06/2011

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