Provider Demographics
NPI:1265681472
Name:CRITTENTON MEDICAL EQUIPMENT, LLC
Entity Type:Organization
Organization Name:CRITTENTON MEDICAL EQUIPMENT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:WHALEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-650-4560
Mailing Address - Street 1:161 SOUTH LIVERNOIS
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307-1837
Mailing Address - Country:US
Mailing Address - Phone:248-650-4560
Mailing Address - Fax:248-650-4563
Practice Address - Street 1:161 S. LIVERNOIS
Practice Address - Street 2:
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-1837
Practice Address - Country:US
Practice Address - Phone:248-650-4560
Practice Address - Fax:248-650-4563
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-11
Last Update Date:2015-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
335E00000X
MI335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1240950001Medicare NSC