Basic Information
| Provider Information | |||||||||
| NPI: | 1275830515 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | OTTAWA REGIONAL DME LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1601 MERCURY CT | ||||||||
| Address2: | SUITE 2 | ||||||||
| City: | OTTAWA | ||||||||
| State: | IL | ||||||||
| PostalCode: | 613509323 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8154333100 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1601 MERCURY CT | ||||||||
| Address2: | SUITE 2 | ||||||||
| City: | OTTAWA | ||||||||
| State: | IL | ||||||||
| PostalCode: | 613509323 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8154333100 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/23/2011 | ||||||||
| LastUpdateDate: | 02/23/2011 | ||||||||
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| AuthorizedOfficialLastName: | TROMPETER | ||||||||
| AuthorizedOfficialFirstName: | DAWN | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHIEF EXECUTIVE OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 8154315458 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X | Y | Suppliers | Durable Medical Equipment & Medical Supplies |
No ID Information.