Provider Demographics
NPI:1003478736
Name:PATRIOT DME INC.
Entity Type:Organization
Organization Name:PATRIOT DME INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:IMPASTATO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-506-0808
Mailing Address - Street 1:510 S GRAND AVE STE 310
Mailing Address - Street 2:
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91741-4207
Mailing Address - Country:US
Mailing Address - Phone:626-594-0192
Mailing Address - Fax:
Practice Address - Street 1:510 S GRAND AVE STE 310
Practice Address - Street 2:
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91741-4207
Practice Address - Country:US
Practice Address - Phone:626-594-0192
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-02
Last Update Date:2019-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies