Provider Demographics
NPI:1588553614
Name:DURABLE MEDICAL
Entity type:Organization
Organization Name:DURABLE MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVANZO
Authorized Official - Middle Name:LAMANAS
Authorized Official - Last Name:TATE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-974-5415
Mailing Address - Street 1:595 CARLOTTA DR
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44504-1321
Mailing Address - Country:US
Mailing Address - Phone:330-506-6635
Mailing Address - Fax:
Practice Address - Street 1:595 CARLOTTA DR
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44504-1321
Practice Address - Country:US
Practice Address - Phone:330-506-6635
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-02
Last Update Date:2025-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies