Provider Demographics
NPI:1760768303
Name:REDEMPTION MEDICAL SUPPLY &EQUIPMENT
Entity Type:Organization
Organization Name:REDEMPTION MEDICAL SUPPLY &EQUIPMENT
Other - Org Name:REDEMPTIONMEDICALSUPPLY&EQUIPMENT
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GREGORY
Authorized Official - Suffix:
Authorized Official - Credentials:SUPPLY
Authorized Official - Phone:407-406-9832
Mailing Address - Street 1:1319 N SAGINAW ST
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48503-1739
Mailing Address - Country:US
Mailing Address - Phone:407-406-9832
Mailing Address - Fax:810-767-9460
Practice Address - Street 1:1319 N SAGINAW ST
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48503-1739
Practice Address - Country:US
Practice Address - Phone:407-406-9832
Practice Address - Fax:810-767-9460
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-27
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI332B00000X
344600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No344600000XTransportation ServicesTaxi