1447207204 NPI number — MEDIC-AIR RESPIRATORY AND MEDICAL SUPPLIES, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447207204 NPI number — MEDIC-AIR RESPIRATORY AND MEDICAL SUPPLIES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MEDIC-AIR RESPIRATORY AND MEDICAL 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:
Provider Other Organization Name Type Code:
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:
1447207204
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/11/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
440 BURROUGHS ST
Provider Second Line Business Mailing Address:
119
Provider Business Mailing Address City Name:
DETROIT
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48202-3429
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
313-262-7243
Provider Business Mailing Address Fax Number:
313-262-7254

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
440 BURROUGHS ST
Provider Second Line Business Practice Location Address:
119
Provider Business Practice Location Address City Name:
DETROIT
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48202-3429
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
313-262-7243
Provider Business Practice Location Address Fax Number:
313-262-7254
Provider Enumeration Date:
05/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CLARK
Authorized Official First Name:
HYLA
Authorized Official Middle Name:
REGENIA
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
313-262-7243

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  332B00000X , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BX2000X , with the licence number: 332BX2000X , 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)





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