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General NPI Number Information
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NPI Number | 1356322390
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Entity Type | Organization
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Legal Business Name | FASSE DABE, LLC
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Dates
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Enumeration Date | 11/08/2005
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Last Update Date | 05/25/2011
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Provider Practice Location Address
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Address Line | 7537 EASY ST
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City | MASON
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State | OH
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Zip | 45040-9421
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Country | US
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Telephone | 513-573-9625
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Fax | 513-573-9628
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Provider Business Mailing Address
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Address Line | 7537 EASY ST
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City | MASON
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State | OH
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Zip | 45040-9421
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Country | US
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Telephone | 513-573-9625
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Fax | 513-573-9828
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Authorized Official
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Title or Position | MEMBER
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Name | MR. KIMBALL LEWIS DABE
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Credential | RRT
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Telephone | 513-573-9625
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BP3500X
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Taxonomy Name | Parenteral & Enteral Nutrition Supplies (DME)
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License Number | HMER22180
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License Number State | OH
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