Provider Demographics
NPI:1205890340
Name:MEDICAL EQUIPMENT DEPOT LLC
Entity type:Organization
Organization Name:MEDICAL EQUIPMENT DEPOT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CALVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BYRD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-353-7791
Mailing Address - Street 1:21315 HILLTOP ST
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48033-4064
Mailing Address - Country:US
Mailing Address - Phone:248-353-7791
Mailing Address - Fax:
Practice Address - Street 1:21315 HILLTOP ST
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48033-4064
Practice Address - Country:US
Practice Address - Phone:248-353-7791
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-14
Last Update Date:2008-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4433852 TYPE 87Medicaid
4426010001Medicare NSC