Provider Demographics
NPI:1710079223
Name:DEGC ENTERPRISES (U.S.), INC.
Entity Type:Organization
Organization Name:DEGC ENTERPRISES (U.S.), INC.
Other - Org Name:CCS MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:HOFMEISTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-628-2100
Mailing Address - Street 1:3030 LBJ FWY STE 1525
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75234-7758
Mailing Address - Country:US
Mailing Address - Phone:972-628-2100
Mailing Address - Fax:
Practice Address - Street 1:5464 E LA PALMA AVE UNIT B
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92807-2023
Practice Address - Country:US
Practice Address - Phone:800-560-0595
Practice Address - Fax:714-696-9021
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DEGC ENTERPRISES (U.S.), INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-29
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1710079223Medicaid
AK1021987Medicaid
CA1710079223Medicaid
AZ097022Medicaid
OR500644400Medicaid
HI554461-01Medicaid