Provider Demographics
NPI:1275737447
Name:1ST CHOICE HOME MEDICAL EQUIPMENT
Entity Type:Organization
Organization Name:1ST CHOICE HOME MEDICAL EQUIPMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MGR
Authorized Official - Prefix:
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:A
Authorized Official - Last Name:CALDWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-837-0100
Mailing Address - Street 1:20101 GREENFIELD RD
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48235-1872
Mailing Address - Country:US
Mailing Address - Phone:313-837-0100
Mailing Address - Fax:313-837-1955
Practice Address - Street 1:20101 GREENFIELD RD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48235-1872
Practice Address - Country:US
Practice Address - Phone:313-837-0100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-12
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1275737447OtherPPOM
MI47932OtherHEALTH PLAN OF MICHIGAN
MI54-0-H2-3355-0OtherBCBSM
MI5227170Medicaid
MI5227170Medicaid