Provider Demographics
NPI:1790881530
Name:DURABLE MEDICAL EQUIPMENT, INC
Entity Type:Organization
Organization Name:DURABLE MEDICAL EQUIPMENT, INC
Other - Org Name:LAKEVIEW MEDICAL INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:
Authorized Official - First Name:TAREK
Authorized Official - Middle Name:
Authorized Official - Last Name:ELSAWY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:508-852-0600
Mailing Address - Street 1:5 NEPONSET ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01606-2714
Mailing Address - Country:US
Mailing Address - Phone:508-852-0600
Mailing Address - Fax:
Practice Address - Street 1:42 SOUTHBRIDGE ST
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:MA
Practice Address - Zip Code:01501-2582
Practice Address - Country:US
Practice Address - Phone:508-407-7700
Practice Address - Fax:508-407-7717
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RELIANT MEDICAL GROUP, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-16
Last Update Date:2019-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAAA31092OtherHARVARD PILGRIM HC
MA2354OtherPAYOR FCHP
MA400154OtherBCBS
MAAA31092OtherHARVARD PILGRIM HC