Provider Demographics
NPI:1578678223
Name:MI-MED SUPPLY CO., INC.
Entity Type:Organization
Organization Name:MI-MED SUPPLY CO., INC.
Other - Org Name:EXPEREA HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT AND DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:M
Authorized Official - Last Name:VESTAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:866-897-8588
Mailing Address - Street 1:PO BOX 674553
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48267-4553
Mailing Address - Country:US
Mailing Address - Phone:760-734-6648
Mailing Address - Fax:772-212-4904
Practice Address - Street 1:1390 DECISION ST STE B
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92081
Practice Address - Country:US
Practice Address - Phone:760-734-6648
Practice Address - Fax:772-607-5274
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1578678223Medicaid
WA1578678223Medicaid
TNQ029227Medicaid
UT1578678223Medicaid
NV1578678223Medicaid
AK1622191Medicaid