Provider Demographics
NPI:1891728341
Name:EVANKO RESPIRATORY, INC
Entity Type:Organization
Organization Name:EVANKO RESPIRATORY, INC
Other - Org Name:DYNAMIC HEALTHCARE SERVICES PA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:GRABKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-657-2100
Mailing Address - Street 1:35 SARHELM RD
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17112-3339
Mailing Address - Country:US
Mailing Address - Phone:717-657-2100
Mailing Address - Fax:717-657-2176
Practice Address - Street 1:321 BERNER AVE
Practice Address - Street 2:
Practice Address - City:HAZLETON
Practice Address - State:PA
Practice Address - Zip Code:18201-7472
Practice Address - Country:US
Practice Address - Phone:570-455-4699
Practice Address - Fax:570-455-3296
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DYNAMIC HEALTHCARE SERVICES INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-08
Last Update Date:2016-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA8000000940332BX2000X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0018612920004Medicaid
PA4184610001Medicare NSC