Provider Demographics
NPI:1447646948
Name:MEDARBOR DME LLC
Entity type:Organization
Organization Name:MEDARBOR DME LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MIROSLAV
Authorized Official - Middle Name:
Authorized Official - Last Name:KESIC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:484-430-1516
Mailing Address - Street 1:150 MONUMENT RD
Mailing Address - Street 2:SUITE 601D
Mailing Address - City:BALA CYNWYD
Mailing Address - State:PA
Mailing Address - Zip Code:19004-1702
Mailing Address - Country:US
Mailing Address - Phone:484-430-1516
Mailing Address - Fax:866-675-0264
Practice Address - Street 1:301 E CITY AVE
Practice Address - Street 2:SUITE 120
Practice Address - City:BALA CYNWYD
Practice Address - State:PA
Practice Address - Zip Code:19004-1708
Practice Address - Country:US
Practice Address - Phone:484-430-1516
Practice Address - Fax:866-675-0264
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-10
Last Update Date:2015-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA6000008706332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies