Provider Demographics
NPI:1508970104
Name:HACKLEY HEALTHCARE EQUIPMENT
Entity Type:Organization
Organization Name:HACKLEY HEALTHCARE EQUIPMENT
Other - Org Name:HACKLEY HEALTHCARE EQUIPMENT & PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:M
Authorized Official - Last Name:BRYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-728-4634
Mailing Address - Street 1:6401 PRAIRIE ST
Mailing Address - Street 2:SUITE 1100
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49444-7840
Mailing Address - Country:US
Mailing Address - Phone:231-727-2966
Mailing Address - Fax:231-727-7964
Practice Address - Street 1:6401 PRAIRIE ST
Practice Address - Street 2:SUITE 1100
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49444-7840
Practice Address - Country:US
Practice Address - Phone:231-727-2966
Practice Address - Fax:231-727-7964
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332BX2000X
MI53010083083336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Not Answered3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0281990006Medicare ID - Type Unspecified