Provider Demographics
NPI:1932322880
Name:DMS MD INC
Entity Type:Organization
Organization Name:DMS MD INC
Other - Org Name:FAMILY & ELDER CARE CENTER INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:MILES
Authorized Official - Last Name:STALMACH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-307-0048
Mailing Address - Street 1:720 BROOKSIDE AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-5189
Mailing Address - Country:US
Mailing Address - Phone:909-307-0048
Mailing Address - Fax:909-307-0372
Practice Address - Street 1:720 BROOKSIDE AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373-0372
Practice Address - Country:US
Practice Address - Phone:909-307-0048
Practice Address - Fax:909-307-0372
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2009-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA50334207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG11055Medicare UPIN
00A503340Medicare ID - Type Unspecified