Provider Demographics
NPI:1063755478
Name:DOCTOR DME, LLC
Entity type:Organization
Organization Name:DOCTOR DME, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORRESPONDENT
Authorized Official - Prefix:
Authorized Official - First Name:SULTANA
Authorized Official - Middle Name:
Authorized Official - Last Name:CRAIGHEAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-498-6888
Mailing Address - Street 1:2363 TELLER RD
Mailing Address - Street 2:#114
Mailing Address - City:NEWBURY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91320-2228
Mailing Address - Country:US
Mailing Address - Phone:805-498-6888
Mailing Address - Fax:805-498-2888
Practice Address - Street 1:2363 TELLER RD
Practice Address - Street 2:#114
Practice Address - City:NEWBURY PARK
Practice Address - State:CA
Practice Address - Zip Code:91320-2228
Practice Address - Country:US
Practice Address - Phone:805-498-6888
Practice Address - Fax:805-498-2888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-03
Last Update Date:2013-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies