MEDICARE: DALLAS EQUIPMENT SUPPLY INC

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		TX

General Provider Information

NPI Number	:	1750703005
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DALLAS EQUIPMENT SUPPLY INC

Provider Business Mailing Address
First Line	:	4347 S HAMPTON RD
Second Line	:	SUITE 129
City	:	DALLAS
State	:	TX
Zip	:	75232-1065
Country	:	US
Telephone Number	:	214-330-7600
Fax Number	:	214-330-7601

Provider Business Practice Location Address
First Line	:	4347 S HAMPTON RD
Second Line	:	SUITE 129
City	:	DALLAS
State	:	TX
Zip	:	75232-1065
Country	:	US
Telephone Number	:	214-330-7600
Fax Number	:	214-330-7601

Authorized Official
Title or Position	:	REGISTERED AGENT/DIRECTOR
Name	:	MARCEL BAKARE
Credential	:
Telephone Number	:	214-854-7710

Provider Enumeration Date	:	01/06/2014
Last Update Date	:	01/27/2014

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