Provider Demographics
NPI:1649331802
Name:PHOENIX MEDICAL EQUIPMENT, INC.
Entity type:Organization
Organization Name:PHOENIX MEDICAL EQUIPMENT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MISS
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:BAYDOUN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-730-0007
Mailing Address - Street 1:3915 S TELEGRAPH RD
Mailing Address - Street 2:
Mailing Address - City:DEARBORN HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48125-1929
Mailing Address - Country:US
Mailing Address - Phone:313-730-0007
Mailing Address - Fax:313-730-0005
Practice Address - Street 1:3915 S TELEGRAPH RD
Practice Address - Street 2:
Practice Address - City:DEARBORN HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48125-1929
Practice Address - Country:US
Practice Address - Phone:313-730-0007
Practice Address - Fax:313-730-0005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2019-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI540H225960OtherBCBS SUPPLIER PIN
MI4805789Medicaid
MI024626OtherMIDWEST HEALTH PLAN PIN #
MI024626OtherMIDWEST HEALTH PLAN PIN #