Provider Demographics
NPI:1750473252
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 1:3601 THIRLANE RD NW STE 4
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24019-3080
Practice Address - Country:US
Practice Address - Phone:866-359-9641
Practice Address - Fax:800-540-2259
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
HI554461-01Medicaid
GA003115482BMedicaid
PA0071099160003Medicaid
WV3810017344Medicaid
CT008051702Medicaid
VA1750473252Medicaid
IL1750473252Medicaid
GA000697903EMedicaid