Provider Demographics
NPI:1003200189
Name:MIDWEST MEDICAL DME ENTERPRISES, LLC
Entity Type:Organization
Organization Name:MIDWEST MEDICAL DME ENTERPRISES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP, OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:GREG
Authorized Official - Middle Name:
Authorized Official - Last Name:MINTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-735-4071
Mailing Address - Street 1:2295 PARKLAKE DR NE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30345-2844
Mailing Address - Country:US
Mailing Address - Phone:678-735-4071
Mailing Address - Fax:770-407-5280
Practice Address - Street 1:2295 PARKLAKE DR NE
Practice Address - Street 2:SUITE 100
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30345-2844
Practice Address - Country:US
Practice Address - Phone:678-735-4071
Practice Address - Fax:770-407-5280
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-26
Last Update Date:2015-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies