Provider Demographics
NPI:1205946241
Name:PRIMARY MEDICAL EQUIPMENT, INC
Entity type:Organization
Organization Name:PRIMARY MEDICAL EQUIPMENT, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GUNABALAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-558-8133
Mailing Address - Street 1:28800 RYAN RD
Mailing Address - Street 2:STE 110A
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48092-4272
Mailing Address - Country:US
Mailing Address - Phone:586-558-8133
Mailing Address - Fax:586-558-8134
Practice Address - Street 1:28800 RYAN RD
Practice Address - Street 2:STE 110A
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48092-4272
Practice Address - Country:US
Practice Address - Phone:586-558-8133
Practice Address - Fax:586-558-8134
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2011-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5776120001Medicare NSC