Provider Demographics
NPI:1053933572
Name:SALTGRASS MEDICAL EQUIPMENT LLC
Entity type:Organization
Organization Name:SALTGRASS MEDICAL EQUIPMENT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LONNIE
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:BLACKBURN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-963-6335
Mailing Address - Street 1:1100 ROUND ROCK AVE STE 107A
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78681-4517
Mailing Address - Country:US
Mailing Address - Phone:512-963-6335
Mailing Address - Fax:
Practice Address - Street 1:1100 ROUND ROCK AVE STE 107A
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-4517
Practice Address - Country:US
Practice Address - Phone:512-963-6335
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-07
Last Update Date:2020-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies