MEDICARE: OTTAWA REGIONAL DME LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1275830515
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OTTAWA REGIONAL DME LLC

Provider Business Mailing Address
First Line	:	1601 MERCURY CT
Second Line	:	SUITE 2
City	:	OTTAWA
State	:	IL
Zip	:	61350-9323
Country	:	US
Telephone Number	:	815-433-3100
Fax Number	:

Provider Business Practice Location Address
First Line	:	1601 MERCURY CT
Second Line	:	SUITE 2
City	:	OTTAWA
State	:	IL
Zip	:	61350-9323
Country	:	US
Telephone Number	:	815-433-3100
Fax Number	:

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	DAWN TROMPETER
Credential	:
Telephone Number	:	815-431-5458

Provider Enumeration Date	:	02/23/2011
Last Update Date	:	02/23/2011

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Directions to “OTTAWA REGIONAL DME LLC ” Practice Location

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