Provider Demographics
NPI:1841534195
Name:DE MEDICAL, LLC
Entity type:Organization
Organization Name:DE MEDICAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:FAIRFIELD
Authorized Official - Last Name:DYER
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:334-444-0535
Mailing Address - Street 1:4135 CARMICHAEL RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36106-3605
Mailing Address - Country:US
Mailing Address - Phone:334-356-4509
Mailing Address - Fax:888-822-1394
Practice Address - Street 1:4135 CARMICHAEL RD
Practice Address - Street 2:SUITE 2
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36106-3605
Practice Address - Country:US
Practice Address - Phone:334-356-4509
Practice Address - Fax:888-822-1394
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-26
Last Update Date:2020-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL6885730001Medicare NSC