Provider Demographics
NPI:1265638530
Name:BAEK & WEEDEN MEDICAL & SPORTS SUPPLIES
Entity Type:Organization
Organization Name:BAEK & WEEDEN MEDICAL & SPORTS SUPPLIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:WEEDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:866-379-2235
Mailing Address - Street 1:24259 SORRENTINO CT
Mailing Address - Street 2:
Mailing Address - City:CLINTON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48035-3237
Mailing Address - Country:US
Mailing Address - Phone:866-379-2235
Mailing Address - Fax:586-790-3667
Practice Address - Street 1:24259 SORRENTINO CT
Practice Address - Street 2:
Practice Address - City:CLINTON TWP
Practice Address - State:MI
Practice Address - Zip Code:48035-3237
Practice Address - Country:US
Practice Address - Phone:866-379-2235
Practice Address - Fax:586-790-3667
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI=========OtherEIN