Provider Demographics
NPI:1982749370
Name:DIVINE MEDICAL EQUIPMENT, INC
Entity type:Organization
Organization Name:DIVINE MEDICAL EQUIPMENT, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:KANAYO
Authorized Official - Middle Name:
Authorized Official - Last Name:ONYECHI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-221-0746
Mailing Address - Street 1:11311 AUDELIA RD APT 110
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-7331
Mailing Address - Country:US
Mailing Address - Phone:214-221-0746
Mailing Address - Fax:214-221-0749
Practice Address - Street 1:11311 AUDELIA RD APT 110
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-7331
Practice Address - Country:US
Practice Address - Phone:214-221-0746
Practice Address - Fax:214-221-0749
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0080696332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0080696OtherSTATE LICENSE
5389730001Medicare NSC