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General NPI Number Information
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NPI Number | 1871812032
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Entity Type | Organization
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Legal Business Name | INTEGRATED DME LLC
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Dates
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Enumeration Date | 05/26/2010
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Last Update Date | 05/26/2010
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Provider Practice Location Address
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Address Line | 2818 EAGLE VALLEY DR
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City | WOODBURY
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State | MN
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Zip | 55129-4263
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Country | US
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Telephone | 952-807-5389
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Fax |
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Provider Business Mailing Address
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Address Line | 2818 EAGLE VALLEY DR
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City | WOODBURY
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State | MN
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Zip | 55129-4263
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. DOUGLAS MACKEY
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Credential |
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Telephone | 952-807-5389
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 3756181-3
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License Number State | MN
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