Provider Demographics
NPI:1114198066
Name:DANA R. HUNTINGTON
Entity Type:Organization
Organization Name:DANA R. HUNTINGTON
Other - Org Name:STATELINE MEDICAL EQUIPMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANA
Authorized Official - Middle Name:R
Authorized Official - Last Name:HUNTINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-452-6270
Mailing Address - Street 1:13 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:OH
Mailing Address - Zip Code:45311-1119
Mailing Address - Country:US
Mailing Address - Phone:937-452-6270
Mailing Address - Fax:937-452-6272
Practice Address - Street 1:13 N MAIN ST
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:OH
Practice Address - Zip Code:45311-1119
Practice Address - Country:US
Practice Address - Phone:937-452-6270
Practice Address - Fax:937-452-6272
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-19
Last Update Date:2010-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2844533Medicaid
OH6106680001Medicare NSC