Provider Demographics
NPI:1730106485
Name:MMS NORTHERN DETROIT, INC
Entity Type:Organization
Organization Name:MMS NORTHERN DETROIT, INC
Other - Org Name:MAJORS MEDICAL SUPPLY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:KATHRYN
Authorized Official - Last Name:REID
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-539-3211
Mailing Address - Street 1:5575 W MAPLE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-3703
Mailing Address - Country:US
Mailing Address - Phone:248-539-3211
Mailing Address - Fax:248-539-3266
Practice Address - Street 1:5775 W MAPLE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-4447
Practice Address - Country:US
Practice Address - Phone:248-539-3211
Practice Address - Fax:248-539-3266
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1040120001Medicare ID - Type Unspecified