Provider Demographics
NPI:1780633503
Name:SAGINAW REHABILITATION SUPPLY
Entity Type:Organization
Organization Name:SAGINAW REHABILITATION SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCDONALD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-793-4444
Mailing Address - Street 1:PO BOX 6393
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48608-6393
Mailing Address - Country:US
Mailing Address - Phone:989-793-6000
Mailing Address - Fax:989-921-0971
Practice Address - Street 1:7620 EASTMAN AVE
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48642-7917
Practice Address - Country:US
Practice Address - Phone:989-793-6000
Practice Address - Fax:989-921-0971
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-09
Last Update Date:2008-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI540G30267OtherBLUE CROSS BLUE SHIELD