Provider Demographics
NPI:1508894189
Name:PIERCE MEDICAL PRODUCTS, INC
Entity Type:Organization
Organization Name:PIERCE MEDICAL PRODUCTS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:PIERCE
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN
Authorized Official - Phone:734-854-7864
Mailing Address - Street 1:8535 SECOR RD
Mailing Address - Street 2:
Mailing Address - City:LAMBERTVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48144-9334
Mailing Address - Country:US
Mailing Address - Phone:734-854-7864
Mailing Address - Fax:734-854-2418
Practice Address - Street 1:8535 SECOR RD
Practice Address - Street 2:
Practice Address - City:LAMBERTVILLE
Practice Address - State:MI
Practice Address - Zip Code:48144-9334
Practice Address - Country:US
Practice Address - Phone:734-854-7864
Practice Address - Fax:734-854-2418
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-30
Last Update Date:2017-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI383209872332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1508894189Medicaid
OH0114843Medicaid
MI3116420Medicaid
IN1508894189Medicaid