Provider Demographics
NPI:1659730802
Name:BENNETT MEDICAL SUPPLY
Entity Type:Organization
Organization Name:BENNETT MEDICAL SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CHADRICK
Authorized Official - Middle Name:FITZGERALD
Authorized Official - Last Name:BENNETT
Authorized Official - Suffix:II
Authorized Official - Credentials:
Authorized Official - Phone:989-670-2415
Mailing Address - Street 1:1315 S COLLING RD
Mailing Address - Street 2:
Mailing Address - City:CARO
Mailing Address - State:MI
Mailing Address - Zip Code:48723-9244
Mailing Address - Country:US
Mailing Address - Phone:989-670-2415
Mailing Address - Fax:
Practice Address - Street 1:1315 S COLLING RD
Practice Address - Street 2:
Practice Address - City:CARO
Practice Address - State:MI
Practice Address - Zip Code:48723-9244
Practice Address - Country:US
Practice Address - Phone:989-670-2415
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-16
Last Update Date:2016-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies