Provider Demographics
NPI:1477880706
Name:DURAMED DURABLE MEDICAL SUPPORTS & EQUIPMENT
Entity Type:Organization
Organization Name:DURAMED DURABLE MEDICAL SUPPORTS & EQUIPMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL PARTNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARJAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HALSTEAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-841-5404
Mailing Address - Street 1:1641 W GLENDALE AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85021-8878
Mailing Address - Country:US
Mailing Address - Phone:602-851-5404
Mailing Address - Fax:602-851-5494
Practice Address - Street 1:1641 W GLENDALE AVE
Practice Address - Street 2:SUITE A
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85021-8878
Practice Address - Country:US
Practice Address - Phone:602-851-5404
Practice Address - Fax:602-851-5494
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-06
Last Update Date:2010-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies