Provider Demographics
NPI:1790302651
Name:DINE DMES LLC
Entity Type:Organization
Organization Name:DINE DMES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:THEODORE
Authorized Official - Middle Name:
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-787-2801
Mailing Address - Street 1:PO BOX 1200B
Mailing Address - Street 2:
Mailing Address - City:LUKACHUKAI
Mailing Address - State:AZ
Mailing Address - Zip Code:86507-1201
Mailing Address - Country:US
Mailing Address - Phone:928-787-2801
Mailing Address - Fax:928-787-2725
Practice Address - Street 1:NR-13 & B.I.A. 134
Practice Address - Street 2:
Practice Address - City:LUKACHUKAI
Practice Address - State:AZ
Practice Address - Zip Code:86507-1200
Practice Address - Country:US
Practice Address - Phone:928-787-2801
Practice Address - Fax:928-787-2725
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-26
Last Update Date:2020-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies