Provider Demographics
NPI:1659902062
Name:SUMMIT DME, LLC
Entity type:Organization
Organization Name:SUMMIT DME, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CASEY
Authorized Official - Middle Name:
Authorized Official - Last Name:CUBBEDGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-256-6456
Mailing Address - Street 1:9357 INTERLINE AVE STE 204
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809-1910
Mailing Address - Country:US
Mailing Address - Phone:225-256-6456
Mailing Address - Fax:225-256-6457
Practice Address - Street 1:9357 INTERLINE AVE STE 204
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-1910
Practice Address - Country:US
Practice Address - Phone:225-256-6456
Practice Address - Fax:225-256-6457
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-04
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies