Provider Demographics
NPI:1508880188
Name:L J MOTOR SALES INC.
Entity Type:Organization
Organization Name:L J MOTOR SALES INC.
Other - Org Name:L J MOBILITY PRODUCTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:GILLILAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:517-817-5454
Mailing Address - Street 1:3018 WILDWOOD AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49202-3969
Mailing Address - Country:US
Mailing Address - Phone:517-817-5454
Mailing Address - Fax:517-817-5455
Practice Address - Street 1:3018 WILDWOOD AVE
Practice Address - Street 2:SUITE C
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49202-3969
Practice Address - Country:US
Practice Address - Phone:517-817-5454
Practice Address - Fax:517-817-5455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4740924Medicaid
MI5366980001Medicare ID - Type Unspecified