Provider Demographics
NPI:1164448619
Name:MASON MEDICAL SUPPLY, LLC
Entity Type:Organization
Organization Name:MASON MEDICAL SUPPLY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:MASON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-288-5725
Mailing Address - Street 1:9500 S DURAND RD
Mailing Address - Street 2:
Mailing Address - City:DURAND
Mailing Address - State:MI
Mailing Address - Zip Code:48429-9466
Mailing Address - Country:US
Mailing Address - Phone:989-288-5725
Mailing Address - Fax:989-288-5729
Practice Address - Street 1:9500 S DURAND RD
Practice Address - Street 2:
Practice Address - City:DURAND
Practice Address - State:MI
Practice Address - Zip Code:48429-9466
Practice Address - Country:US
Practice Address - Phone:989-288-5725
Practice Address - Fax:989-288-5729
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4303880001Medicare ID - Type UnspecifiedDME, P & O