Provider Demographics
NPI:1700187705
Name:INDEPENDENT MEDICAL SUPPLY COMANY
Entity Type:Organization
Organization Name:INDEPENDENT MEDICAL SUPPLY COMANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHELLEY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:WANSHON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-756-6872
Mailing Address - Street 1:14486 OXFORD
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48170-2674
Mailing Address - Country:US
Mailing Address - Phone:734-756-6872
Mailing Address - Fax:734-404-6478
Practice Address - Street 1:14486 OXFORD
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MI
Practice Address - Zip Code:48170-2674
Practice Address - Country:US
Practice Address - Phone:734-756-6872
Practice Address - Fax:734-404-6478
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-06
Last Update Date:2010-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies