Provider Demographics
NPI:1447721410
Name:DYNAMIC DME, LLC
Entity type:Organization
Organization Name:DYNAMIC DME, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:NOVACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-270-2691
Mailing Address - Street 1:851 SE 6TH AVE STE C
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33483-5276
Mailing Address - Country:US
Mailing Address - Phone:561-270-2691
Mailing Address - Fax:
Practice Address - Street 1:885 SE 6TH AVE STE C
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33483-5184
Practice Address - Country:US
Practice Address - Phone:561-270-2691
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-17
Last Update Date:2018-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies