Provider Demographics
NPI:1710084496
Name:DARAH MEDICAL EQUIPMENT AND SUPPLIES LLC
Entity Type:Organization
Organization Name:DARAH MEDICAL EQUIPMENT AND SUPPLIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:LOUIS
Authorized Official - Last Name:DARAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-697-5456
Mailing Address - Street 1:1013 STARR AVE
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43605-2464
Mailing Address - Country:US
Mailing Address - Phone:419-697-5456
Mailing Address - Fax:419-878-8518
Practice Address - Street 1:1013 STARR AVE
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43605-2464
Practice Address - Country:US
Practice Address - Phone:419-697-5456
Practice Address - Fax:419-878-8518
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2705595Medicaid
OH000000505927OtherANTHEM BLUE CROSS
OH87726OtherUNITED HEALTHCARE
OH87726OtherUNITED HEALTHCARE