MEDICARE: DURABLE MEDICAL

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	:	1588553614
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DURABLE MEDICAL

Provider Business Mailing Address
First Line	:	595 CARLOTTA DR
Second Line	:
City	:	YOUNGSTOWN
State	:	OH
Zip	:	44504-1321
Country	:	US
Telephone Number	:	330-506-6635
Fax Number	:

Provider Business Practice Location Address
First Line	:	595 CARLOTTA DR
Second Line	:
City	:	YOUNGSTOWN
State	:	OH
Zip	:	44504-1321
Country	:	US
Telephone Number	:	330-506-6635
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DAVANZO LAMANAS TATE
Credential	:
Telephone Number	:	330-974-5415

Provider Enumeration Date	:	07/02/2025
Last Update Date	:	07/02/2025

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Directions to “DURABLE MEDICAL ” Practice Location

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