Provider Demographics
NPI:1386114965
Name:DYNAMIC MEDICAL LLC
Entity type:Organization
Organization Name:DYNAMIC MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:ANDERSON
Authorized Official - Last Name:COLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-632-8460
Mailing Address - Street 1:935 3RD STREET
Mailing Address - Street 2:
Mailing Address - City:VINTON
Mailing Address - State:VA
Mailing Address - Zip Code:24179-3302
Mailing Address - Country:US
Mailing Address - Phone:540-375-2631
Mailing Address - Fax:540-375-2636
Practice Address - Street 1:935 3RD STREET
Practice Address - Street 2:
Practice Address - City:VINTON
Practice Address - State:VA
Practice Address - Zip Code:24179-3302
Practice Address - Country:US
Practice Address - Phone:540-375-2631
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-27
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory