Provider Demographics
NPI:1992862320
Name:RGNL MED SPLY LLC
Entity Type:Organization
Organization Name:RGNL MED SPLY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:IKECHUKWU
Authorized Official - Middle Name:C
Authorized Official - Last Name:ODUM
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:734-528-1767
Mailing Address - Street 1:2880 WASHTENAW RD
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-1507
Mailing Address - Country:US
Mailing Address - Phone:734-528-1767
Mailing Address - Fax:734-528-2767
Practice Address - Street 1:2880 WASHTENAW RD
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-1507
Practice Address - Country:US
Practice Address - Phone:734-528-1767
Practice Address - Fax:734-528-2767
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2008-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5850070001Medicare NSC