Provider Demographics
NPI:1477803476
Name:JUSTICE MEDICAL SOURCE,INC.
Entity Type:Organization
Organization Name:JUSTICE MEDICAL SOURCE,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:T
Authorized Official - Last Name:DANNA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-212-6625
Mailing Address - Street 1:725 THURBER DR
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48085-4887
Mailing Address - Country:US
Mailing Address - Phone:248-212-6625
Mailing Address - Fax:
Practice Address - Street 1:725 THURBER DR
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48085-4887
Practice Address - Country:US
Practice Address - Phone:248-212-6625
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-17
Last Update Date:2012-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies