Provider Demographics
NPI:1629404892
Name:DME OF YUMA LLC
Entity Type:Organization
Organization Name:DME OF YUMA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:SERGIO
Authorized Official - Middle Name:I
Authorized Official - Last Name:MACIAS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:928-722-6050
Mailing Address - Street 1:PO BOX 5841
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85366-2490
Mailing Address - Country:US
Mailing Address - Phone:928-722-6050
Mailing Address - Fax:928-722-6094
Practice Address - Street 1:1233 N MAIN STREET
Practice Address - Street 2:STE. 10
Practice Address - City:SAN LUIS
Practice Address - State:AZ
Practice Address - Zip Code:85349
Practice Address - Country:US
Practice Address - Phone:928-722-6050
Practice Address - Fax:928-722-6094
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ADULT AND PEDIATRIC REHABILITATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-09-19
Last Update Date:2013-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4377332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies