Provider Demographics
NPI:1639115462
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:208-322-5055
Mailing Address - Street 1:3036 E LANARK ST
Mailing Address - Street 2:UNIT B
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-5918
Mailing Address - Country:US
Mailing Address - Phone:208-322-5055
Mailing Address - Fax:208-322-8033
Practice Address - Street 1:3036 E LANARK ST
Practice Address - Street 2:UNIT B
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-5918
Practice Address - Country:US
Practice Address - Phone:208-322-5055
Practice Address - Fax:208-322-8033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-21
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
ID000010152453OtherREGENCE BLUE SHIELD OF ID
OR213648Medicaid
OR213648Medicaid