Provider Demographics
NPI:1245590892
Name:EASTERN DME
Entity type:Organization
Organization Name:EASTERN DME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:GUSTAVO
Authorized Official - Middle Name:ADOLFO
Authorized Official - Last Name:URBINA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-495-3796
Mailing Address - Street 1:6508 S 27TH ST
Mailing Address - Street 2:SUITE 9-194
Mailing Address - City:OAK CREEK
Mailing Address - State:WI
Mailing Address - Zip Code:53154-1093
Mailing Address - Country:US
Mailing Address - Phone:414-409-7646
Mailing Address - Fax:
Practice Address - Street 1:6508 S 27TH ST
Practice Address - Street 2:SUITE 9-194
Practice Address - City:OAK CREEK
Practice Address - State:WI
Practice Address - Zip Code:53154-1093
Practice Address - Country:US
Practice Address - Phone:414-409-7646
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-16
Last Update Date:2012-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies