Provider Demographics
NPI:1235372848
Name:STATELINE MEDICAL EQUIPMENT, INC
Entity Type:Organization
Organization Name:STATELINE MEDICAL EQUIPMENT, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
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:PO BOX 1206
Mailing Address - Street 2:
Mailing Address - City:MIAMISBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45343-1206
Mailing Address - Country:US
Mailing Address - Phone:937-452-6270
Mailing Address - Fax:937-452-6272
Practice Address - Street 1:153 N ALEX RD
Practice Address - Street 2:
Practice Address - City:MIAMISBURG
Practice Address - State:OH
Practice Address - Zip Code:45342-3076
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:2009-04-13
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3102001Medicaid
OH2844533Medicaid
OH6426780001Medicare NSC