Provider Demographics
NPI:1497767636
Name:WV DURABLE MEDICAL EQUIPMENT CO, LLC
Entity Type:Organization
Organization Name:WV DURABLE MEDICAL EQUIPMENT CO, LLC
Other - Org Name:MEDCARE WV
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:CHRISTOPHER
Authorized Official - Last Name:PALLOTTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-692-9730
Mailing Address - Street 1:PO BOX 469
Mailing Address - Street 2:
Mailing Address - City:FAIRMONT
Mailing Address - State:WV
Mailing Address - Zip Code:26555-0469
Mailing Address - Country:US
Mailing Address - Phone:304-367-1088
Mailing Address - Fax:304-367-1066
Practice Address - Street 1:34 OAKWOOD RD
Practice Address - Street 2:
Practice Address - City:FAIRMONT
Practice Address - State:WV
Practice Address - Zip Code:26554-2465
Practice Address - Country:US
Practice Address - Phone:304-367-1088
Practice Address - Fax:304-367-1066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-13
Last Update Date:2008-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810007649Medicaid
WV3810007649Medicaid