Healthcare Provider Details

I. General information

NPI: 1093631129
Provider Name (Legal Business Name): ICONIC DME LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2026
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 PROVIDENCE HWY
WALPOLE MA
02081-2553
US

IV. Provider business mailing address

1600 PROVIDENCE HWY
WALPOLE MA
02081-2553
US

V. Phone/Fax

Practice location:
  • Phone: 888-446-4118
  • Fax: 888-804-0426
Mailing address:
  • Phone: 888-446-4118
  • Fax: 888-804-0426

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: DANIEL WHITE
Title or Position: MANAGER
Credential:
Phone: 888-446-4118