Provider Demographics
NPI:1497314249
Name:DME BY PREVENTIVE HEALTH CARE USA LLC
Entity Type:Organization
Organization Name:DME BY PREVENTIVE HEALTH CARE USA LLC
Other - Org Name:DME BY PREVENTIVE HEALTH CARE USA LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:SINGLE MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:CLOWERS
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:678-371-2952
Mailing Address - Street 1:1572 HIGHWAY 85 N STE 211
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-7726
Mailing Address - Country:US
Mailing Address - Phone:678-371-2952
Mailing Address - Fax:
Practice Address - Street 1:1572 HIGHWAY 85 N STE 211
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-7726
Practice Address - Country:US
Practice Address - Phone:678-371-2952
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-06
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies