1457538100 NPI number — DME UNITED, INC.

Table of content: (NPI 1457538100)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457538100 NPI number — DME UNITED, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DME UNITED, INC.
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:
1457538100
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/17/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2221 MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BELLEVUE
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68005-5239
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-898-2675
Provider Business Mailing Address Fax Number:
402-898-2679

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2221 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BELLEVUE
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68005-5239
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-898-2675
Provider Business Practice Location Address Fax Number:
402-898-2679
Provider Enumeration Date:
01/24/2008

Additional Information

Authorized Official

Authorized Official Last Name:
SHANNON
Authorized Official First Name:
PATRICK
Authorized Official Middle Name:
M
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
402-898-2675

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  255258 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BC3200X , with the licence number: 255258 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2981082 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 041640500 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 10025691000 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0702789 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1889849 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 08518 . This is a "NE BCBS" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 1457538100 . This is a "TRICARE" identifier . This identifiers is of the category "OTHER".




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