Active NPI
Djo, LLC
- Durable Medical Equipment & Medical Supplies
- Holt, MI
National Provider Identifier
1003632084
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Durable Medical Equipment & Medical Supplies
- Legal business name
- DJO, LLC
- Practice address
- 2373 Cedar Park Dr Ste 100
Holt, MI 48842-3102 - Phone
- (517) 908-0280
- NPI assigned
- Nov 25, 2024
- Last updated
- Dec 5, 2025
- Organization subpart
- Yes
- Parent organization
- DJO, LLC
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mr. Andres Moreno III
- Title
- President
- Phone
- (800) 321-9549
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | Primary | ||
| Customized Equipment (DME) | 332BC3200X | |||
| Prosthetic/Orthotic Supplier | 335E00000X |
Addresses
Primary practice location
2373 Cedar Park Dr Ste 100
Holt, MI 48842-3102
Mailing address
2900 Lake Vista Dr Ste 200
Lewisville, TX 75067-3889
Phone (704) 749-6291
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MI
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20260430004450 | MI | DME Supplier - Medical Supply Company | 1456472703 | Practice locations: Holt, MI |
Other NPIs with the same Medicare PAC ID 6
NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).
Laboratory certificates & supplier records
Derived by NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| Djo, LLC | Heat & Cold Applications|Osteogenesis Stimulators|Canes and/or Crutches|Walkers|Orthoses: Custom Fabricated|Orthoses: Prefabricated (Non-Custom Fabricated)|Orthoses: Off-The-Shelf | Accepts assignment |
National Provider Directory
National Provider Directory- Tax ID family
- Djo LLC
- Part of
- Djo LLC
Other organizations with this tax ID 9
Organizations that report the same tax identification number in the National Provider Directory.
-
- Durable Medical Equipment & Medical Supplies
- Littleton, CO
- NPI 1013812155
-
- Durable Medical Equipment & Medical Supplies
- Apollo Beach, FL
- NPI 1023296035
-
- Durable Medical Equipment & Medical Supplies
- Hixson, TN
- NPI 1033980271
-
- Durable Medical Equipment & Medical Supplies
- Overland Park, KS
- NPI 1053195446
-
- Durable Medical Equipment & Medical Supplies
- Carlsbad, CA
- NPI 1497731533
-
- Durable Medical Equipment & Medical Supplies
- Vista, CA
- NPI 1518708320
-
- Durable Medical Equipment & Medical Supplies
- Saint Paul, MN
- NPI 1780459388
-
- Durable Medical Equipment & Medical Supplies
- Goshen, IN
- NPI 1861267460
-
- Durable Medical Equipment & Medical Supplies
- Lewisville, TX
- NPI 1982345302
Locations
2373 Cedar Park Dr
Holt, MI 48842
Phone (517) 347-0220
2373 Cedar Park Dr
Ste 100
Holt, MI 48842
Phone (517) 908-0280
Ownership & related parties
Parent organization (reported in NPPES) 1
This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1732492800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1764892800000",
"number": "1003632084",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2900 LAKE VISTA DR STE 200",
"city": "LEWISVILLE",
"state": "TX",
"postal_code": "750673889",
"telephone_number": "704-749-6291",
"fax_number": "704-831-8300"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2373 CEDAR PARK DR STE 100",
"city": "HOLT",
"state": "MI",
"postal_code": "488423102",
"telephone_number": "517-908-0280"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "DJO, LLC",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "DJO, LLC",
"enumeration_date": "2024-11-25",
"last_updated": "2025-12-05",
"certification_date": "2025-12-05",
"status": "A",
"authorized_official_last_name": "MORENO",
"authorized_official_first_name": "ANDRES",
"authorized_official_title_or_position": "PRESIDENT",
"authorized_official_telephone_number": "800-321-9549",
"authorized_official_name_prefix": "Mr.",
"authorized_official_name_suffix": "III"
},
"taxonomies": [
{
"code": "332B00000X",
"taxonomy_group": "",
"desc": "Durable Medical Equipment & Medical Supplies",
"state": null,
"license": null,
"primary": true
},
{
"code": "332BC3200X",
"taxonomy_group": "",
"desc": "Durable Medical Equipment & Medical Supplies, Customized Equipment",
"state": null,
"license": null,
"primary": false
},
{
"code": "335E00000X",
"taxonomy_group": "",
"desc": "Prosthetic/Orthotic Supplier",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Holt, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.