Provider Demographics
NPI:1588610349
Name:DYNAMED INC
Entity Type:Organization
Organization Name:DYNAMED INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:HUNT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:298-322-5055
Mailing Address - Street 1:1404 W IDAHO STREET
Mailing Address - Street 2:#104
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702-5345
Mailing Address - Country:US
Mailing Address - Phone:208-322-5055
Mailing Address - Fax:208-322-6033
Practice Address - Street 1:14415 SPRAGUE AVE
Practice Address - Street 2:#7
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99216
Practice Address - Country:US
Practice Address - Phone:509-922-4075
Practice Address - Fax:509-922-4189
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9053547Medicaid