Provider Demographics
NPI:1447331533
Name:MD MEDICAL ENTERPRISES, LLC
Entity type:Organization
Organization Name:MD MEDICAL ENTERPRISES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:PETTIT
Authorized Official - Suffix:
Authorized Official - Credentials:RPSGT
Authorized Official - Phone:541-683-3325
Mailing Address - Street 1:1845 HWY. 126
Mailing Address - Street 2:A-4
Mailing Address - City:FLORENCE
Mailing Address - State:OR
Mailing Address - Zip Code:97439
Mailing Address - Country:US
Mailing Address - Phone:541-683-3325
Mailing Address - Fax:541-343-4117
Practice Address - Street 1:1845 HWY. 126
Practice Address - Street 2:A-4
Practice Address - City:FLORENCE
Practice Address - State:OR
Practice Address - Zip Code:97439
Practice Address - Country:US
Practice Address - Phone:541-683-3325
Practice Address - Fax:541-343-4117
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies