Provider Demographics
NPI:1417065327
Name:CHARLES EDWARD PAVEY
Entity Type:Organization
Organization Name:CHARLES EDWARD PAVEY
Other - Org Name:MEDCARE SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:PAVEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-469-0622
Mailing Address - Street 1:18822 MONICA DR
Mailing Address - Street 2:
Mailing Address - City:CLINTON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48036-4204
Mailing Address - Country:US
Mailing Address - Phone:586-469-0622
Mailing Address - Fax:586-469-1392
Practice Address - Street 1:18822 MONICA DR
Practice Address - Street 2:
Practice Address - City:CLINTON TWP
Practice Address - State:MI
Practice Address - Zip Code:48036-4204
Practice Address - Country:US
Practice Address - Phone:586-469-0622
Practice Address - Fax:586-469-1392
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2011-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI0396430001332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3053527Medicaid
MI0396430001Medicare NSC
MIOD403549-54-2Medicare ID - Type Unspecified