Provider Demographics
NPI:1114984929
Name:DEWALL ENTERPRISES INC
Entity Type:Organization
Organization Name:DEWALL ENTERPRISES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:L
Authorized Official - Last Name:DEWALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-552-0432
Mailing Address - Street 1:4506 LEAVENWORTH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68106-1419
Mailing Address - Country:US
Mailing Address - Phone:402-552-0432
Mailing Address - Fax:402-552-0315
Practice Address - Street 1:4506 LEAVENWORTH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68106-1419
Practice Address - Country:US
Practice Address - Phone:402-552-0432
Practice Address - Fax:402-552-0315
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0551598Medicaid
1027556OtherUNITED HEALTHCARE
1027556OtherUNITED HEALTHCARE
0457990001Medicare ID - Type Unspecified