1699770008 NPI number — DEPENDABLE MEDICAL EQUIPMENT, INC

Table of content: (NPI 1699770008)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699770008 NPI number — DEPENDABLE MEDICAL EQUIPMENT, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DEPENDABLE MEDICAL EQUIPMENT, 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:
1699770008
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/21/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3570 S DODGE BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TUCSON
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85713-5419
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
520-751-1929
Provider Business Mailing Address Fax Number:
520-207-2865

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
557 N GRAND AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NOGALES
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85621-2973
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
520-751-1929
Provider Business Practice Location Address Fax Number:
520-207-2865
Provider Enumeration Date:
06/14/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BAKER
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
520-751-1929

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332B00000X , with the licence number: 10198920 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: AX4351 . This is a "HEALTH NET OF AZ" identifier . This identifiers is of the category "OTHER".
  • Identifier: AZ0278520 . This is a "BLUE CROSS/BLUE SHIELD AZ" identifier . This identifiers is of the category "OTHER".