Organization
STATELINE MEDICAL EQUIPMENT
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. DANA RENEE HUNTINGTON (OWNER)
(765) 732-4112
Entity
Organization
Contact information
Practice address
630 LIBERTY AVE, WEST COLLEGE CORNER, IN 47003
(765) 732-3947
(765) 732-3940
Mailing address
PO BOX 704, WEST COLLEGE CORNER, IN 47003-0704
(765) 732-3947
(765) 732-3940
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
332B00000X
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200838850A
—
IN
05
—
2693278
—
OH
Enumeration date
08/17/2006
Last updated
06/18/2008
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