Organization Name: | ETAIL MEDICAL LLC |
NPI Number: | 1346577715 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | RICK ALAN DEZENGREMEL (CO CEO/PRESIDENT) |
Mailing Address: | 5156 Rialto Dr Parker |
State: | CO US |
Postal Code: | 801345234 |
Phone Number: | 3036675929 |
Fax Number: | 3033793775 |
NPI Enumeration Date: | 11/05/2009 |
NPI Last Update Date: | 11/05/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 332B00000X |
License Number: | 20091385108 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CO |
Taxonomy Type: | Suppliers |
Taxonomy Classification: | Durable Medical Equipment & Medical Supplies |
Taxonomy Specialization: | |
Taxonomy Definition: | A supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient |