Provider Demographics
NPI:1346240744
Name:MEDICAL NUTRITIONAL SERVICES, INC.
Entity Type:Organization
Organization Name:MEDICAL NUTRITIONAL SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:MR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:HANSINGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-469-0060
Mailing Address - Street 1:44752 MORLEY DR
Mailing Address - Street 2:
Mailing Address - City:CLINTON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48036-1357
Mailing Address - Country:US
Mailing Address - Phone:586-469-0060
Mailing Address - Fax:586-469-0111
Practice Address - Street 1:44752 MORLEY DR
Practice Address - Street 2:
Practice Address - City:CLINTON TWP
Practice Address - State:MI
Practice Address - Zip Code:48036-1357
Practice Address - Country:US
Practice Address - Phone:586-469-0060
Practice Address - Fax:586-469-0111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIME0113181332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0E00360OtherBLUE CROSS BLUE SHIELD
MI1946792Medicaid
MI0E00360OtherBLUE CROSS BLUE SHIELD
MI0646700001Medicare ID - Type Unspecified