1326106030 NPI number — AMERICAN DURABLE MEDICAL EQUIPMENT AND SUPPLIES LLC

Table of content: (NPI 1326106030)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326106030 NPI number — AMERICAN DURABLE MEDICAL EQUIPMENT AND SUPPLIES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AMERICAN DURABLE MEDICAL EQUIPMENT AND SUPPLIES LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
AMERICAN DME & SUPPLIES
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1326106030
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/25/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
21901 HARPER AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAINT CLAIR SHORES
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48080-2217
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
586-863-1840
Provider Business Mailing Address Fax Number:
586-863-1841

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
21901 HARPER AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAINT CLAIR SHORES
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48080-2217
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
586-863-1840
Provider Business Practice Location Address Fax Number:
586-863-1841
Provider Enumeration Date:
12/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
OWOROETOP
Authorized Official First Name:
MFON
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT/CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
15868631840

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 540E017240 . This is a "BLUE CARE NETWORK" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 4538970 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4834100001 . This is a "ABP ADMINISTRATION" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 540H21560 . This is a "BCBS-MI FED EMPLOYEE PROG" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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