Provider Demographics
NPI:1043286768
Name:PATRIOT PRODUCTS, INC.
Entity Type:Organization
Organization Name:PATRIOT PRODUCTS, INC.
Other - Org Name:PATRIOT PRODUCTS 1, INC.
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:D
Authorized Official - Last Name:GRUDZIEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-704-3474
Mailing Address - Street 1:4064 TECHNOLOGY DRIVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:MAUMEE
Mailing Address - State:OH
Mailing Address - Zip Code:43537
Mailing Address - Country:US
Mailing Address - Phone:419-865-9713
Mailing Address - Fax:419-865-9721
Practice Address - Street 1:4064 TECHNOLOGY DRIVE
Practice Address - Street 2:SUITE C
Practice Address - City:MAUMEE
Practice Address - State:OH
Practice Address - Zip Code:43537
Practice Address - Country:US
Practice Address - Phone:419-865-9713
Practice Address - Fax:419-865-9721
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-23
Last Update Date:2014-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHHMEL 11039332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4645193Medicaid
OH2129995Medicaid
OH5250660001Medicare NSC