Provider Demographics
NPI:1255391900
Name:MANE MEDICAL EQUIPMENT & SUPPLIES, INC.
Entity type:Organization
Organization Name:MANE MEDICAL EQUIPMENT & SUPPLIES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ENENE
Authorized Official - Middle Name:OKON
Authorized Official - Last Name:IBAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-557-2898
Mailing Address - Street 1:25511 SOUTHFIELD RD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-1856
Mailing Address - Country:US
Mailing Address - Phone:248-557-2898
Mailing Address - Fax:248-557-2899
Practice Address - Street 1:25511 SOUTHFIELD RD
Practice Address - Street 2:SUITE 120
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-1856
Practice Address - Country:US
Practice Address - Phone:248-557-2898
Practice Address - Fax:248-557-2899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIB-332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4788015Medicaid
MI5498320001Medicare NSC