Provider Demographics
NPI:1427275619
Name:DAT FS2 INC
Entity type:Organization
Organization Name:DAT FS2 INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:TOMM
Authorized Official - Middle Name:O
Authorized Official - Last Name:KLEYENSTEUBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-628-1001
Mailing Address - Street 1:6359 W REDFIELD RD
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85306-3765
Mailing Address - Country:US
Mailing Address - Phone:623-776-0430
Mailing Address - Fax:623-776-0643
Practice Address - Street 1:6359 W REDFIELD RD
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306-3765
Practice Address - Country:US
Practice Address - Phone:623-776-0430
Practice Address - Fax:623-776-0643
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2007-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ20085770332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ5546660001Medicare ID - Type Unspecified