Provider Demographics
NPI:1275830515
Name:OTTAWA REGIONAL DME LLC
Entity Type:Organization
Organization Name:OTTAWA REGIONAL DME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:TROMPETER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-431-5458
Mailing Address - Street 1:1601 MERCURY CT
Mailing Address - Street 2:SUITE 2
Mailing Address - City:OTTAWA
Mailing Address - State:IL
Mailing Address - Zip Code:61350-9323
Mailing Address - Country:US
Mailing Address - Phone:815-433-3100
Mailing Address - Fax:
Practice Address - Street 1:1601 MERCURY CT
Practice Address - Street 2:SUITE 2
Practice Address - City:OTTAWA
Practice Address - State:IL
Practice Address - Zip Code:61350-9323
Practice Address - Country:US
Practice Address - Phone:815-433-3100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-23
Last Update Date:2011-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies