Provider Demographics
NPI:1902083918
Name:BORDER LINE D.M.E.
Entity Type:Organization
Organization Name:BORDER LINE D.M.E.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:IRAIS
Authorized Official - Middle Name:
Authorized Official - Last Name:LONGORIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-458-1895
Mailing Address - Street 1:2608 E 29TH ST
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78574-2077
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2800 W. EXPRESSWAY 83
Practice Address - Street 2:
Practice Address - City:SULLIVAN
Practice Address - State:TX
Practice Address - Zip Code:78595
Practice Address - Country:US
Practice Address - Phone:956-400-8843
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-22
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies