Provider Demographics
NPI:1184653024
Name:ORBIT MEDICAL PRODUCTS OF MADISON HEIGHTS LLC
Entity Type:Organization
Organization Name:ORBIT MEDICAL PRODUCTS OF MADISON HEIGHTS LLC
Other - Org Name:ORBIT MEDICAL PRODUCTS OF MADISON HEIGHTS INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SENIOR DIRECTOR OF PAYOR RELATIONS
Authorized Official - Prefix:
Authorized Official - First Name:KILEY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:RUSSELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:629-252-8211
Mailing Address - Street 1:9495 WINNETKA AVE N STE 200
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55445-1618
Mailing Address - Country:US
Mailing Address - Phone:629-252-8211
Mailing Address - Fax:763-255-3972
Practice Address - Street 1:25157 DEQUINDRE RD
Practice Address - Street 2:
Practice Address - City:MADISON HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48071-4240
Practice Address - Country:US
Practice Address - Phone:248-658-6212
Practice Address - Fax:248-658-6216
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-02
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI87-4863601Medicaid
MI5720890001Medicare NSC