Provider Demographics
NPI:1578564852
Name:GREAT LAKES MEDICAL EQUIPMENT, INC.
Entity Type:Organization
Organization Name:GREAT LAKES MEDICAL EQUIPMENT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:COLLEEN
Authorized Official - Middle Name:SHAUGHNESSY
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:517-536-7350
Mailing Address - Street 1:PO BOX 1402
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49204
Mailing Address - Country:US
Mailing Address - Phone:517-536-7350
Mailing Address - Fax:517-536-0671
Practice Address - Street 1:2301 E MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49202-3700
Practice Address - Country:US
Practice Address - Phone:517-536-7350
Practice Address - Fax:517-536-0671
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI57478OtherNORTHWOOD NPN
MIXX20420OtherHEALTHPLUS OF MI
MI1431OtherNORTHWOOD, INC.
MI540C80499OtherBLUE CROSS BLUE SHIELD MI
MI2889073Medicaid
MI57478OtherNORTHWOOD NPN