Provider Demographics
NPI:1780631218
Name:CORR MEDICAL SUPPLIES & EQUIPMENT
Entity Type:Organization
Organization Name:CORR MEDICAL SUPPLIES & EQUIPMENT
Other - Org Name:CORR MEDICAL SUPPLIES & EQUIPMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CLEMENT
Authorized Official - Middle Name:FRANCIS
Authorized Official - Last Name:EKPENYONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-216-9733
Mailing Address - Street 1:PO BOX 28365
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48228-0365
Mailing Address - Country:US
Mailing Address - Phone:313-216-9733
Mailing Address - Fax:313-216-9734
Practice Address - Street 1:17010 WEST WARREN AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48228-3566
Practice Address - Country:US
Practice Address - Phone:313-216-9733
Practice Address - Fax:313-216-9734
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIA332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI=========OtherDME
MI5014880001Medicare NSC