Provider Demographics
NPI:1669455176
Name:DETROIT OXYGEN & MEDICAL EQUIPMENT CO.
Entity Type:Organization
Organization Name:DETROIT OXYGEN & MEDICAL EQUIPMENT CO.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-756-1400
Mailing Address - Street 1:24560 FORTERRA DR
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48089-4371
Mailing Address - Country:US
Mailing Address - Phone:586-756-1400
Mailing Address - Fax:
Practice Address - Street 1:24560 FORTERRA DR
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48089-4371
Practice Address - Country:US
Practice Address - Phone:586-756-1400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-29
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIBME-0104426332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI236008OtherNCPDP
MI1702616Medicaid
MI5301005160OtherPHARMACY LICENSE
MI5301005160OtherPHARMACY LICENSE
MI5301005160OtherPHARMACY LICENSE
0409040001Medicare NSC