Provider Demographics
NPI:1437515293
Name:DYNAMIC DURABLE MEDICAL EQUIPMENT LLC
Entity Type:Organization
Organization Name:DYNAMIC DURABLE MEDICAL EQUIPMENT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:VAUGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-708-2681
Mailing Address - Street 1:5900 N GRANITE REEF RD
Mailing Address - Street 2:SUITE 107
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85250-6279
Mailing Address - Country:US
Mailing Address - Phone:480-248-8006
Mailing Address - Fax:888-796-1832
Practice Address - Street 1:5900 N GRANITE REEF RD
Practice Address - Street 2:SUITE 107
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85250-6279
Practice Address - Country:US
Practice Address - Phone:480-248-8006
Practice Address - Fax:888-796-1832
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-10
Last Update Date:2016-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies