Provider Demographics
NPI:1912096504
Name:DEPENDABLE MEDICAL SUPPLIES HOLDING, LLC
Entity Type:Organization
Organization Name:DEPENDABLE MEDICAL SUPPLIES HOLDING, LLC
Other - Org Name:DEPENDABLE MEDICAL SUPPLIES, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:J
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-753-6000
Mailing Address - Street 1:9510 ORMSBY STATION RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-4081
Mailing Address - Country:US
Mailing Address - Phone:502-753-5656
Mailing Address - Fax:502-753-0803
Practice Address - Street 1:9510 ORMSBY STATION RD
Practice Address - Street 2:SUITE 101
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40223-4081
Practice Address - Country:US
Practice Address - Phone:502-753-5656
Practice Address - Fax:502-753-0803
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY90012329Medicaid
KY000000384675OtherANTHEM HEALTH PLANS OF KY
KY90012329Medicaid