Provider Demographics
NPI:1528015195
Name:OCTAGON MEDICAL SUPPLIES, INC.
Entity Type:Organization
Organization Name:OCTAGON MEDICAL SUPPLIES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:ABRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-423-9886
Mailing Address - Street 1:17700 NORTHLAND PARK CT
Mailing Address - Street 2:SUITE 16
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-4302
Mailing Address - Country:US
Mailing Address - Phone:248-423-9886
Mailing Address - Fax:248-423-4570
Practice Address - Street 1:17700 NORTHLAND PARK CT
Practice Address - Street 2:SUITE 16
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-4302
Practice Address - Country:US
Practice Address - Phone:248-423-9886
Practice Address - Fax:248-423-4570
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5671250001Medicare NSC