Healthcare Provider Details

I. General information

NPI: 1003312141
Provider Name (Legal Business Name): DYNAMIC MEDICAL EQUIPMENT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2018
Last Update Date: 04/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10236 W NATIONAL AVE
WEST ALLIS WI
53227
US

IV. Provider business mailing address

6400 INDUSTRIAL LOOP
GREENDALE WI
53129-2452
US

V. Phone/Fax

Practice location:
  • Phone: 414-210-3987
  • Fax: 414-210-4685
Mailing address:
  • Phone: 414-858-4106
  • Fax: 414-423-4134

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: SALISTINA JOSEPH
Title or Position: PRESIDENT
Credential:
Phone: 414-210-3987