Provider Demographics
NPI:1760913677
Name:DME & SUPPLIES LLC
Entity Type:Organization
Organization Name:DME & SUPPLIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:WALLACE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-985-2985
Mailing Address - Street 1:9701 APOLLO DR STE 105
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-4785
Mailing Address - Country:US
Mailing Address - Phone:301-985-2985
Mailing Address - Fax:240-565-6034
Practice Address - Street 1:9701 APOLLO DR STE 105
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:MD
Practice Address - Zip Code:20774-4785
Practice Address - Country:US
Practice Address - Phone:301-985-2985
Practice Address - Fax:240-565-6034
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-22
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD16166763332B00000X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD05005571OtherAMERIGROUP
MD444313600Medicaid
MDDG60OtherCAREFIRST BLUECHOICE
5906592OtherCIGNA
MDDG60OtherCAREFIRST BLUECROSS BLUESHIELD
VA2021218766Medicaid
DE250694969Medicaid
DCDG60OtherCAREFIRST CHPDC
SCDM1697Medicaid
MDMDPRV00024017OtherAETNA BETTER HEALTH
DC05005571OtherAMERIGROUP
DC60402094OtherAMERI HEALTH CARITAS DC
DC060653859Medicaid
DC10085097OtherMEDSTAR FAMILY CHOICE OF DC
MD10085097OtherMEDSTAR FAMILY CHOICE OF MD
MDPDXGR13328727OtherAETNA BETTER HEALTH OF MD