MEDICARE: IMPACTDME 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	:	1861805475
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IMPACTDME LLC

Provider Business Mailing Address
First Line	:	1127 ELDRIDGE PKWY
Second Line	:	SUITE 300-370
City	:	HOUSTON
State	:	TX
Zip	:	77077-1771
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1888 STEBBINS DR STE 100A
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77043-2841
Country	:	US
Telephone Number	:	832-819-3120
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	PATRICK DAVIDSON
Credential	:	BA, MA
Telephone Number	:	248-626-3100

Provider Enumeration Date	:	06/11/2014
Last Update Date	:	04/30/2025

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Directions to “IMPACTDME LLC ” Practice Location

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