Provider Demographics
NPI:1912301680
Name:PATRIOTS SUPPLY INC.
Entity Type:Organization
Organization Name:PATRIOTS SUPPLY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:WARREN
Authorized Official - Last Name:RUDOWSKI
Authorized Official - Suffix:II
Authorized Official - Credentials:PHD
Authorized Official - Phone:586-489-1193
Mailing Address - Street 1:15760 19 MILE RD
Mailing Address - Street 2:SUITE E
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-6319
Mailing Address - Country:US
Mailing Address - Phone:586-489-1193
Mailing Address - Fax:586-416-2580
Practice Address - Street 1:15760 19 MILE RD
Practice Address - Street 2:SUITE E
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48038-6319
Practice Address - Country:US
Practice Address - Phone:586-489-1193
Practice Address - Fax:586-416-2580
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-09
Last Update Date:2014-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies