Provider Demographics
NPI:1457758351
Name:MILLPORT HOLDINGS DME LLC
Entity type:Organization
Organization Name:MILLPORT HOLDINGS DME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:E
Authorized Official - Last Name:SWANSON
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:205-662-3862
Mailing Address - Street 1:PO BOX 308
Mailing Address - Street 2:13530 HWY 96
Mailing Address - City:MILLPORT
Mailing Address - State:AL
Mailing Address - Zip Code:35576
Mailing Address - Country:US
Mailing Address - Phone:205-662-3862
Mailing Address - Fax:
Practice Address - Street 1:13530 HWY 96
Practice Address - Street 2:
Practice Address - City:MILLPORT
Practice Address - State:AL
Practice Address - Zip Code:35576
Practice Address - Country:US
Practice Address - Phone:205-662-3862
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-21
Last Update Date:2015-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL168697625OtherBLUE CROSS BLUE SHELD