Provider Demographics
NPI:1710932371
Name:DOMINION DME, INC.
Entity Type:Organization
Organization Name:DOMINION DME, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOANNA
Authorized Official - Middle Name:WELLS
Authorized Official - Last Name:KIBWE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-838-4054
Mailing Address - Street 1:1618 HARDY CASH DR
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23666-2400
Mailing Address - Country:US
Mailing Address - Phone:757-838-4054
Mailing Address - Fax:757-838-8899
Practice Address - Street 1:1618 HARDY CASH DR
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-2400
Practice Address - Country:US
Practice Address - Phone:757-838-4054
Practice Address - Fax:757-838-8899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
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
VA9190899Medicaid
VA4500230001Medicare ID - Type UnspecifiedDURABLE MEDICAL EQUIPMENT