Healthcare Provider Details

I. General information

NPI: 1821789553
Provider Name (Legal Business Name): DURABLE MEDICAL EQUIPMENT & OTC STORE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2023
Last Update Date: 05/15/2023
Certification Date: 05/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1702 TODDS LN STE 172
HAMPTON VA
23666-3196
US

IV. Provider business mailing address

4001 MOUNT LAUREL RD
WILLIAMSBURG VA
23188-6613
US

V. Phone/Fax

Practice location:
  • Phone: 757-870-9833
  • Fax:
Mailing address:
  • Phone: 757-870-9833
  • 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 Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332BD1200X
TaxonomyDialysis Equipment & Supplies (DME)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: MRS. LESLIE A YOUNG
Title or Position: CEO
Credential:
Phone: 757-870-9833