Provider Demographics
NPI:1295177863
Name:DOMINION MEDICAL EQUIPMENT CONSORTIUM, LLC
Entity Type:Organization
Organization Name:DOMINION MEDICAL EQUIPMENT CONSORTIUM, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:FELIX
Authorized Official - Middle Name:A
Authorized Official - Last Name:OWOLABI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-570-4860
Mailing Address - Street 1:5513 YORK RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21212-3804
Mailing Address - Country:US
Mailing Address - Phone:443-570-4860
Mailing Address - Fax:410-800-2506
Practice Address - Street 1:5513 YORK RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21212-3804
Practice Address - Country:US
Practice Address - Phone:443-825-2955
Practice Address - Fax:410-800-2506
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-24
Last Update Date:2022-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR3289R332B00000X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD430903100Medicaid