Provider Demographics
NPI:1588662258
Name:RENEES SURVIVOR SHOP LLC
Entity Type:Organization
Organization Name:RENEES SURVIVOR SHOP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:MICHELE
Authorized Official - Last Name:SCHICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-471-0603
Mailing Address - Street 1:5401 SECOR RD
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43623-1930
Mailing Address - Country:US
Mailing Address - Phone:419-471-0603
Mailing Address - Fax:419-471-0090
Practice Address - Street 1:5401 SECOR RD
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43623-1930
Practice Address - Country:US
Practice Address - Phone:419-471-0603
Practice Address - Fax:419-471-0090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-07
Last Update Date:2010-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000336645OtherANTHEM
OH110284OtherPPOM
OH04564OtherPARAMOUNT
MI874675764Medicaid
OH7434617OtherAETNA
MI874675764Medicaid
OH=========002OtherMEDICAL MUTUAL
OH110284OtherPPOM