1205823531 NPI number — DURAMED EQUIPMENT, LLC

Table of content: (NPI 1205823531)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205823531 NPI number — DURAMED EQUIPMENT, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DURAMED EQUIPMENT, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1205823531
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/03/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
207 PORTAGE TRAIL EXT W
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
CUYAHOGA FALLS
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44223-1297
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-487-1075
Provider Business Mailing Address Fax Number:
773-439-8958

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
207 PORTAGE TRAIL EXT W
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
CUYAHOGA FALLS
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44223-1297
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-487-1075
Provider Business Practice Location Address Fax Number:
773-439-8958
Provider Enumeration Date:
10/03/2005

Additional Information

Authorized Official

Authorized Official Last Name:
MUNTEAN
Authorized Official First Name:
EARL
Authorized Official Middle Name:
P
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
330-487-1075

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  1535579 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 7704584 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2716798 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: DM1200 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".




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