Provider Demographics
NPI:1326072919
Name:NETTIE D., LLC
Entity Type:Organization
Organization Name:NETTIE D., LLC
Other - Org Name:BP GAMMA MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:L
Authorized Official - Last Name:MENCHEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-822-4600
Mailing Address - Street 1:PO BOX 27968
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84127-0968
Mailing Address - Country:US
Mailing Address - Phone:570-966-8030
Mailing Address - Fax:800-868-3117
Practice Address - Street 1:7118 GEOFFREY WAY
Practice Address - Street 2:SUITE P
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21704-7106
Practice Address - Country:US
Practice Address - Phone:301-874-3390
Practice Address - Fax:301-694-9348
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ROTECH HEALTHCARE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-10
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD10200163332B00000X
332BC3200X, 332BP3500X, 332BX2000X, 335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD4052471-00Medicaid
WV3810021092Medicaid
VA010108934Medicaid
PA1027810900002Medicaid
DC036387100Medicaid
DE200043711Medicaid