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General NPI Number Information
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NPI Number | 1386918936
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Entity Type | Organization
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Legal Business Name | DME ACCESS LLC
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Dates
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Enumeration Date | 02/29/2012
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Last Update Date | 02/29/2012
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Provider Practice Location Address
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Address Line | 9016 58TH PL STE 400
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City | KENOSHA
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State | WI
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Zip | 53144-7814
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Country | US
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Telephone | 262-605-1300
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Fax | 262-605-1301
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Provider Business Mailing Address
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Address Line | 1717 INDUSTRIAL DR
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City | MONTGOMERY
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State | IL
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Zip | 60538-1233
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Country | US
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Telephone | 630-892-7400
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Fax | 630-892-7401
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | PAUL CREATURA
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Credential |
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Telephone | 630-892-7400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number | IL 02838
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License Number State | IL
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