904 West Main LLC

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

Legal business name

904 WEST MAIN LLC

Practice address

615 W Broadway
Farmington, NM 87401-5910

Phone

(505) 535-4196

NPI assigned

Sep 2, 2024

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Kurt Cook

Title

Ceo

Phone

(505) 793-6750

Specialties & licenses 1

Addresses

Other names 1

• Direct Medical Equipment Doing business as

Tax ID family

904 West Main LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• 904 West Main LLC

  • Non-emergency Medical Transport (VAN)
  • Farmington, NM
  • NPI 1003517228
  NPD tax ID

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• 904 West Main LLC

  • Non-emergency Medical Transport (VAN)
  • Farmington, NM
  • NPI 1003517228

  Member Of

  NPD member

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1725235200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1781222400000",
    "number": "1235964172",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "615 W BROADWAY",
            "city": "FARMINGTON",
            "state": "NM",
            "postal_code": "874015910",
            "telephone_number": "505-535-4196"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "615 W BROADWAY",
            "city": "FARMINGTON",
            "state": "NM",
            "postal_code": "874015910",
            "telephone_number": "505-535-4196"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "904 WEST MAIN LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-09-02",
        "last_updated": "2026-06-12",
        "certification_date": "2026-06-12",
        "status": "A",
        "authorized_official_last_name": "COOK",
        "authorized_official_first_name": "KURT",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "505-793-6750"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Direct Medical Equipment",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• 1918 Winter Street Operating Co LLC
• 3501 North Butler Avenue Farmington Professional LLC
• 48New Mexico Treatment Services
• 6588 East Main Farmington LLC
• 904 West Main LLC
• A Better Hearing Solution, Inc.
• A Helping Hand HHC
• Abaton Counseling LLC
• Rita Abboud, FNP-C
• Tia Leigh Abeita

• Durable Medical Equipment & Medical Supplies in Farmington, NM
• Providers in Farmington, NM by specialty
• Durable Medical Equipment & Medical Supplies in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.