Provider Demographics
NPI:1326106030
Name:AMERICAN DURABLE MEDICAL EQUIPMENT AND SUPPLIES LLC
Entity Type:Organization
Organization Name:AMERICAN DURABLE MEDICAL EQUIPMENT AND SUPPLIES LLC
Other - Org Name:AMERICAN DME & SUPPLIES
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT/CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MFON
Authorized Official - Middle Name:
Authorized Official - Last Name:OWOROETOP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:1586-863-1840
Mailing Address - Street 1:21901 HARPER AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48080-2217
Mailing Address - Country:US
Mailing Address - Phone:586-863-1840
Mailing Address - Fax:586-863-1841
Practice Address - Street 1:21901 HARPER AVE
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48080-2217
Practice Address - Country:US
Practice Address - Phone:586-863-1840
Practice Address - Fax:586-863-1841
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2012-01-25
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
MI540E017240OtherBLUE CARE NETWORK
MI4538970Medicaid
MI4834100001OtherABP ADMINISTRATION
MI540H21560OtherBCBS-MI FED EMPLOYEE PROG
MI4538970Medicaid