Basic Information
| Provider Information | |||||||||
| NPI: | 1568695476 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DEPENDABLE MEDICAL EQUIPMENT, INC. | ||||||||
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| OtherOrganizationName: | DEPENDABLE MEDICAL EQUIPMENT, LLC | ||||||||
| OtherOrganizationType: | 4 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5959 SHALLOWFORD ROAD | ||||||||
| Address2: | STE 443 | ||||||||
| City: | CHATTANOOGA | ||||||||
| State: | TN | ||||||||
| PostalCode: | 374212245 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4237562268 | ||||||||
| FaxNumber: | 4233625413 | ||||||||
| Practice Location | |||||||||
| Address1: | 6601 220TH ST SW | ||||||||
| Address2: | STE 6 | ||||||||
| City: | MOUNTLAKE TERRACE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980432166 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4255631050 | ||||||||
| FaxNumber: | 4255631051 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/25/2009 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| AuthorizedOfficialLastName: | MATUKEWICZ | ||||||||
| AuthorizedOfficialFirstName: | JEFFREY | ||||||||
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| AuthorizedOfficialTitleorPosition: | SECRETARY | ||||||||
| AuthorizedOfficialTelephone: | 4237562268 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332BC3200X | N | Suppliers | Durable Medical Equipment & Medical Supplies | Customized Equipment | 332B00000X | Y | Suppliers | Durable Medical Equipment & Medical Supplies |
ID Information
| ID | Type | State | Issuer | Description | 9063108 | 05 | WA | MEDICAID |