Organization
DEWALL ENTERPRISES INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TERRY L DEWALL (PRESIDENT)
(402) 552-0432
Entity
Organization
Contact information
Practice address
4506 LEAVENWORTH ST, OMAHA, NE 68106-1419
(402) 552-0432
(402) 552-0315
Mailing address
4506 LEAVENWORTH ST, OMAHA, NE 68106-1419
(402) 552-0432
(402) 552-0315
Taxonomy
Speciality
Code
Description
License number
State
332BC3200X
Customized Equipment (DME)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0551598
—
IA
01
—
1027556
UNITED HEALTHCARE
—
Enumeration date
04/26/2006
Last updated
08/22/2020
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