Provider Demographics
NPI:1437356508
Name:CDM SUPPLY, LLC
Entity Type:Organization
Organization Name:CDM SUPPLY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DALE
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:RUNGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-781-7690
Mailing Address - Street 1:N50W13740 OVERVIEW DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:MENOMONEE FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:53051-7062
Mailing Address - Country:US
Mailing Address - Phone:262-781-7690
Mailing Address - Fax:262-781-7692
Practice Address - Street 1:N50W13740 OVERVIEW DR
Practice Address - Street 2:SUITE B
Practice Address - City:MENOMONEE FALLS
Practice Address - State:WI
Practice Address - Zip Code:53051-7062
Practice Address - Country:US
Practice Address - Phone:262-781-7690
Practice Address - Fax:262-781-7692
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-01
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BN1400XSuppliersDurable Medical Equipment & Medical SuppliesNursing Facility Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41569100Medicaid
WI5980340001Medicare NSC