Provider Demographics
NPI:1235389347
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: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:765-732-3947
Mailing Address - Street 1:630 LIBERTY AVENUE
Mailing Address - Street 2:
Mailing Address - City:WEST COLLEGE CORNER
Mailing Address - State:IN
Mailing Address - Zip Code:47003-9308
Mailing Address - Country:US
Mailing Address - Phone:765-732-3947
Mailing Address - Fax:765-732-3940
Practice Address - Street 1:630 LIBERTY AVENUE
Practice Address - Street 2:
Practice Address - City:WEST COLLEGE CORNER
Practice Address - State:IN
Practice Address - Zip Code:47003-9308
Practice Address - Country:US
Practice Address - Phone:765-732-3947
Practice Address - Fax:765-732-3940
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-25
Last Update Date:2009-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200838850AMedicaid
OH2902989Medicaid
OH2899029Medicaid
IN6106680002Medicare NSC