Provider Demographics
NPI:1447207204
Name:MEDIC-AIR RESPIRATORY AND MEDICAL SUPPLIES, LLC
Entity Type:Organization
Organization Name:MEDIC-AIR RESPIRATORY AND MEDICAL SUPPLIES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:HYLA
Authorized Official - Middle Name:REGENIA
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-262-7243
Mailing Address - Street 1:440 BURROUGHS ST
Mailing Address - Street 2:119
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48202-3429
Mailing Address - Country:US
Mailing Address - Phone:313-262-7243
Mailing Address - Fax:313-262-7254
Practice Address - Street 1:440 BURROUGHS ST
Practice Address - Street 2:119
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202-3429
Practice Address - Country:US
Practice Address - Phone:313-262-7243
Practice Address - Fax:313-262-7254
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI332B00000X332B00000X
MI332BX2000X332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Not Answered332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies