Provider Demographics
NPI:1851529218
Name:DURABLE MEDICAL EQUIPMENT AND SUPPLIES A DIVISION OF IQHC CORPORATION
Entity Type:Organization
Organization Name:DURABLE MEDICAL EQUIPMENT AND SUPPLIES A DIVISION OF IQHC CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ADAEZE
Authorized Official - Middle Name:
Authorized Official - Last Name:OZIRI
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:513-731-3338
Mailing Address - Street 1:2837 BURNET AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45219-2401
Mailing Address - Country:US
Mailing Address - Phone:513-731-3338
Mailing Address - Fax:513-731-3777
Practice Address - Street 1:6937 N MAIN ST
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45415-2506
Practice Address - Country:US
Practice Address - Phone:937-277-4888
Practice Address - Fax:937-278-9999
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INTERNATIONAL QUALITY HEALTHCARE CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-06-24
Last Update Date:2009-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH998356332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2500921Medicaid