Provider Demographics
NPI:1902033525
Name:OLD WORLD DME, INC.
Entity Type:Organization
Organization Name:OLD WORLD DME, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BILLY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:248-669-2416
Mailing Address - Street 1:7475 SHEFFIELD
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-2878
Mailing Address - Country:US
Mailing Address - Phone:248-669-2416
Mailing Address - Fax:248-671-0922
Practice Address - Street 1:7475 SHEFFIELD
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-2878
Practice Address - Country:US
Practice Address - Phone:248-669-2416
Practice Address - Fax:248-671-0922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-22
Last Update Date:2019-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI332B00000X, 332BX2000X
335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
0F38288OtherBCBS
MI0F38288OtherBCBSM
MI0F38288OtherBCBSM MEDICARE ADVANTAGE BLUE PPO
0F38288OtherBCBS
0F38288OtherBCBS