Provider Demographics
NPI:1043401060
Name:LESLIE COUNTY DURABLE MEDICAL EQUIPMENT
Entity Type:Organization
Organization Name:LESLIE COUNTY DURABLE MEDICAL EQUIPMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:LAVONNE
Authorized Official - Last Name:MCINTOSH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-374-6873
Mailing Address - Street 1:4898 HIGHWAY 406
Mailing Address - Street 2:
Mailing Address - City:STINNETT
Mailing Address - State:KY
Mailing Address - Zip Code:40868-6513
Mailing Address - Country:US
Mailing Address - Phone:606-374-6873
Mailing Address - Fax:606-374-6873
Practice Address - Street 1:4898 HIGHWAY 406
Practice Address - Street 2:
Practice Address - City:STINNETT
Practice Address - State:KY
Practice Address - Zip Code:40868-6513
Practice Address - Country:US
Practice Address - Phone:606-374-6873
Practice Address - Fax:606-374-6873
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-05
Last Update Date:2007-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment