Provider Demographics
NPI:1891778502
Name:COMMUNITY MEDICAL EQUIPMENT
Entity Type:Organization
Organization Name:COMMUNITY MEDICAL EQUIPMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:MAZUREK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-359-1963
Mailing Address - Street 1:21505 VAN BORN RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:TAYLOR
Mailing Address - State:MI
Mailing Address - Zip Code:48180-1337
Mailing Address - Country:US
Mailing Address - Phone:313-359-1963
Mailing Address - Fax:313-359-1966
Practice Address - Street 1:21505 VAN BORN RD
Practice Address - Street 2:
Practice Address - City:TAYLOR
Practice Address - State:MI
Practice Address - Zip Code:48180-1337
Practice Address - Country:US
Practice Address - Phone:313-359-1963
Practice Address - Fax:313-359-1966
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-28
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIA ME 0155462332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0 H2 1732OtherBCBS OF MI #
MI4627435Medicaid
MI1290990001Medicare NSC