Healthcare Provider Details

I. General information

NPI: 1912721697
Provider Name (Legal Business Name): DME BILLING ENTERPRISES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/11/2024
Last Update Date: 01/10/2025
Certification Date: 01/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1309 COFFEEN AVE STE 15521
SHERIDAN WY
82801-5777
US

IV. Provider business mailing address

1309 COFFEEN AVE STE 15521
SHERIDAN WY
82801-5777
US

V. Phone/Fax

Practice location:
  • Phone: 909-347-0645
  • Fax:
Mailing address:
  • Phone: 909-347-0645
  • 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

VIII. Authorized Official

Name: KRISHNA PENUGONDA
Title or Position: SHARE HOLDER OWNER
Credential:
Phone: 909-347-0645