Provider Demographics
NPI:1790955029
Name:MIKE'S HOME MEDICAL
Entity Type:Organization
Organization Name:MIKE'S HOME MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DALWUAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-680-2225
Mailing Address - Street 1:5504 STAPLES MILL PLZ
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22193-3247
Mailing Address - Country:US
Mailing Address - Phone:703-680-2225
Mailing Address - Fax:703-680-2011
Practice Address - Street 1:5504 STAPLES MILL PLZ
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22193-3247
Practice Address - Country:US
Practice Address - Phone:703-680-2225
Practice Address - Fax:703-680-2011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-03
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0206009425332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies