Healthcare Provider Details

I. General information

NPI: 1952948002
Provider Name (Legal Business Name): ALEXANDRIA DURABLE MEDICAL EQUIPMENT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2019
Last Update Date: 12/09/2019
Certification Date: 12/09/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8242 ALEXANDRIA PIKE STE 100
ALEXANDRIA KY
41001-1162
US

IV. Provider business mailing address

8242 ALEXANDRIA PIKE STE 100
ALEXANDRIA KY
41001-1162
US

V. Phone/Fax

Practice location:
  • Phone: 859-908-0690
  • Fax:
Mailing address:
  • Phone: 859-908-0690
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: DILLON GREENE
Title or Position: OWNER MANAGING MEMBER
Credential:
Phone: 859-663-0698