Provider Demographics
NPI:1336280403
Name:DELTA MEDICAL EQUIPMENT,LLC
Entity Type:Organization
Organization Name:DELTA MEDICAL EQUIPMENT,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:CHARMAINE
Authorized Official - Last Name:FREEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-586-0553
Mailing Address - Street 1:5678 W BROWN DEER RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53223-2365
Mailing Address - Country:US
Mailing Address - Phone:414-586-0553
Mailing Address - Fax:414-586-0551
Practice Address - Street 1:5678 W BROWN DEER RD
Practice Address - Street 2:SUITE 2
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53223-2365
Practice Address - Country:US
Practice Address - Phone:414-586-0553
Practice Address - Fax:414-586-0551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI004000231718601332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41748500Medicaid
WI41748500Medicaid