Provider Demographics
NPI:1154089753
Name:INNOVATIVE DME SOLUTIONS LLC
Entity Type:Organization
Organization Name:INNOVATIVE DME SOLUTIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ CEO
Authorized Official - Prefix:
Authorized Official - First Name:TEMOER
Authorized Official - Middle Name:L
Authorized Official - Last Name:TERRY
Authorized Official - Suffix:IV
Authorized Official - Credentials:
Authorized Official - Phone:888-464-9015
Mailing Address - Street 1:2310 PARKLAKE DR NE STE 125
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30345-2968
Mailing Address - Country:US
Mailing Address - Phone:888-464-9015
Mailing Address - Fax:
Practice Address - Street 1:2310 PARKLAKE DR NE STE 125
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30345-2913
Practice Address - Country:US
Practice Address - Phone:404-604-9902
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-01
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies