MEDICARE: SILVER LINE NRB 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	:	1972341493
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SILVER LINE NRB LLC

Provider Business Mailing Address
First Line	:	2351 W NORTHWEST HWY STE 3238
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75220-4433
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2351 W NORTHWEST HWY STE 3238
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75220-4433
Country	:	US
Telephone Number	:	214-242-8829
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	NOEL RODRIGUEZ BLANCO
Credential	:
Telephone Number	:	214-242-8829

Provider Enumeration Date	:	07/18/2024
Last Update Date	:	07/18/2024

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