Provider Demographics
NPI:1194358465
Name:DURABLE MEDICAL SUPPLY
Entity Type:Organization
Organization Name:DURABLE MEDICAL SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:DEZMEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:HEWITT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-302-3140
Mailing Address - Street 1:344 LONDON BRIDGE RD STE F
Mailing Address - Street 2:
Mailing Address - City:LAKE HAVASU CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86403-4619
Mailing Address - Country:US
Mailing Address - Phone:928-302-3140
Mailing Address - Fax:928-302-3139
Practice Address - Street 1:344 LONDON BRIDGE RD STE F
Practice Address - Street 2:
Practice Address - City:LAKE HAVASU CITY
Practice Address - State:AZ
Practice Address - Zip Code:86403-4619
Practice Address - Country:US
Practice Address - Phone:928-302-3140
Practice Address - Fax:928-302-3139
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-14
Last Update Date:2020-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies