Provider Demographics
NPI:1326049818
Name:DIAL MEDICAL DIRECT INC
Entity Type:Organization
Organization Name:DIAL MEDICAL DIRECT INC
Other - Org Name:DIAL DIABETIC SUPPLIES INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JILL
Authorized Official - Middle Name:D
Authorized Official - Last Name:WELCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-741-2020
Mailing Address - Street 1:27 OCEAN ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-2854
Mailing Address - Country:US
Mailing Address - Phone:207-741-2020
Mailing Address - Fax:207-741-2005
Practice Address - Street 1:27 OCEAN ST
Practice Address - Street 2:SUITE 1
Practice Address - City:SOUTH PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106-2854
Practice Address - Country:US
Practice Address - Phone:207-741-2020
Practice Address - Fax:207-741-2005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-09
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME1024028332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME024358OtherBLUE CROSS BS (ANTHEM)
MEE=========Medicaid
1037440001Medicare ID - Type Unspecified