Provider Demographics
NPI:1003174152
Name:DURAMAX MEDICAL SUPPLY, INC.
Entity Type:Organization
Organization Name:DURAMAX MEDICAL SUPPLY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-601-9618
Mailing Address - Street 1:9427 CONANT ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:HAMTRAMCK
Mailing Address - State:MI
Mailing Address - Zip Code:48212-3689
Mailing Address - Country:US
Mailing Address - Phone:586-601-9618
Mailing Address - Fax:860-631-9618
Practice Address - Street 1:9427 CONANT ST
Practice Address - Street 2:SUITE A
Practice Address - City:HAMTRAMCK
Practice Address - State:MI
Practice Address - Zip Code:48212-3689
Practice Address - Country:US
Practice Address - Phone:586-601-9618
Practice Address - Fax:860-631-9618
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-26
Last Update Date:2014-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6929950001OtherMEDICARE PTAN
MI6929950001OtherMEDICARE PTAN