Stateline Medical Equipment

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

License

332B00000X

Legal business name

STATELINE MEDICAL EQUIPMENT

Practice address

630 Liberty Ave
West College Corner, IN 47003

Phone

(765) 732-3947

Fax

(765) 732-3940

NPI assigned

Aug 17, 2006

Last updated

Jun 18, 2008By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Dana Renee Huntington

Title

Owner

Phone

(765) 732-4112

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1155772800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1213747200000",
    "number": "1417060955",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 704",
            "city": "WEST COLLEGE CORNER",
            "state": "IN",
            "postal_code": "470030704",
            "telephone_number": "765-732-3947",
            "fax_number": "765-732-3940"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "630 LIBERTY AVE",
            "city": "WEST COLLEGE CORNER",
            "state": "IN",
            "postal_code": "47003",
            "telephone_number": "765-732-3947",
            "fax_number": "765-732-3940"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STATELINE MEDICAL EQUIPMENT",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-17",
        "last_updated": "2008-06-18",
        "status": "A",
        "authorized_official_last_name": "HUNTINGTON",
        "authorized_official_first_name": "DANA",
        "authorized_official_middle_name": "RENEE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "765-732-4112",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": "332B00000X",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200838850A",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2693278",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Dana R. Huntington (Stateline Medical Equipment)
• Stateline Regional Therapist

• Durable Medical Equipment & Medical Supplies in West College Corner, IN
• Providers in West College Corner, IN by specialty
• Durable Medical Equipment & Medical Supplies in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.