1558320812 NPI number — DIRECT MEDICAL EQUIPMENT

Table of content: (NPI 1558320812)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558320812 NPI number — DIRECT MEDICAL EQUIPMENT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DIRECT MEDICAL EQUIPMENT
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:
1558320812
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
52502 GRAND RIVER AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WIXOM
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48393-2318
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-491-0276
Provider Business Mailing Address Fax Number:
248-491-0279

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
52502 GRAND RIVER AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WIXOM
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48393-2318
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-491-0276
Provider Business Practice Location Address Fax Number:
248-491-0279
Provider Enumeration Date:
03/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
POLLICELLA
Authorized Official First Name:
ANTHONY
Authorized Official Middle Name:
WILLIAM
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
734-451-1414

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332BC3200X , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BX2000X , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 540H220960 . This is a "BLUE CROSS OF MICHIGAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 145537 . This is a "GREAT LAKES HMO" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 30242 . This is a "HEALTH PLAN OF MICHIGAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 11389 . This is a "CAPE HMO" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 4491239 . This is a "MOLINA" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 4491239 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 540F340020 . This is a "BLUE CROSS OF MICHIGAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 136043 . This is a "CARE CHOICES" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: DM15364 . This is a "MCARE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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