Provider Demographics
NPI:1609873611
Name:MEDSUPPLY CORPORATION, INC.
Entity Type:Organization
Organization Name:MEDSUPPLY CORPORATION, INC.
Other - Org Name:MEDSUPPLY CORP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MOHAMMAD
Authorized Official - Middle Name:ASHRAF
Authorized Official - Last Name:QAZI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-386-0300
Mailing Address - Street 1:33333 DEQUINDRE RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-4624
Mailing Address - Country:US
Mailing Address - Phone:248-597-9004
Mailing Address - Fax:248-597-9012
Practice Address - Street 1:33333 DEQUINDRE RD
Practice Address - Street 2:SUITE A
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083-4624
Practice Address - Country:US
Practice Address - Phone:248-597-9004
Practice Address - Fax:248-597-9012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-05
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4577093Medicaid
MI540F317600OtherBCBSM
MI4577093Medicaid