Provider Demographics
NPI:1609203637
Name:DYNAMIC DME, INC
Entity Type:Organization
Organization Name:DYNAMIC DME, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REVENUE CYCLE MANAGEMENT
Authorized Official - Prefix:
Authorized Official - First Name:NATALY
Authorized Official - Middle Name:
Authorized Official - Last Name:NI
Authorized Official - Suffix:
Authorized Official - Credentials:RCM
Authorized Official - Phone:323-201-8440
Mailing Address - Street 1:5875 S EASTERN AVE
Mailing Address - Street 2:
Mailing Address - City:COMMERCE
Mailing Address - State:CA
Mailing Address - Zip Code:90040-4001
Mailing Address - Country:US
Mailing Address - Phone:323-201-8440
Mailing Address - Fax:888-872-4399
Practice Address - Street 1:5875 S EASTERN AVE
Practice Address - Street 2:
Practice Address - City:COMMERCE
Practice Address - State:CA
Practice Address - Zip Code:90040-4001
Practice Address - Country:US
Practice Address - Phone:323-201-8440
Practice Address - Fax:888-872-4399
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-04
Last Update Date:2013-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23162332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA59761OtherFIRM LICENSE NUMBER
CA23162OtherHOME MEDICAL DEVICE RETAIL EXEMPTEE LINCENSE