Provider Demographics
NPI:1558320812
Name:DIRECT MEDICAL EQUIPMENT
Entity Type:Organization
Organization Name:DIRECT MEDICAL EQUIPMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:POLLICELLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-451-1414
Mailing Address - Street 1:52502 GRAND RIVER AVE
Mailing Address - Street 2:
Mailing Address - City:WIXOM
Mailing Address - State:MI
Mailing Address - Zip Code:48393-2318
Mailing Address - Country:US
Mailing Address - Phone:248-491-0276
Mailing Address - Fax:248-491-0279
Practice Address - Street 1:52502 GRAND RIVER AVE
Practice Address - Street 2:
Practice Address - City:WIXOM
Practice Address - State:MI
Practice Address - Zip Code:48393-2318
Practice Address - Country:US
Practice Address - Phone:248-491-0276
Practice Address - Fax:248-491-0279
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI332B00000X, 332BC3200X, 332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI540H220960OtherBLUE CROSS OF MICHIGAN
MI145537OtherGREAT LAKES HMO
MI30242OtherHEALTH PLAN OF MICHIGAN
MI11389OtherCAPE HMO
MI4491239OtherMOLINA
MI4491239Medicaid
MI540F340020OtherBLUE CROSS OF MICHIGAN
MI136043OtherCARE CHOICES
MIDM15364OtherMCARE
MI11389OtherCAPE HMO
MI4491239OtherMOLINA
MI=========OtherCARELINK
MI=========OtherPPOM
MI=========OtherPRIORITY HEALTH
MI30242OtherHEALTH PLAN OF MICHIGAN
MI136043OtherCARE CHOICES
MI=========OtherGENTIVA/CIGNA