Healthcare Provider Details

I. General information

NPI: 1710932371
Provider Name (Legal Business Name): DOMINION DME, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1618 HARDY CASH DR
HAMPTON VA
23666-2400
US

IV. Provider business mailing address

1618 HARDY CASH DR
HAMPTON VA
23666-2400
US

V. Phone/Fax

Practice location:
  • Phone: 757-838-4054
  • Fax: 757-838-8899
Mailing address:
  • Phone: 757-838-4054
  • Fax: 757-838-8899

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: MRS. JOANNA WELLS KIBWE
Title or Position: ADMINISTRATOR
Credential:
Phone: 757-838-4054