Provider Demographics
NPI:1932266079
Name:MEDWARE L L C
Entity Type:Organization
Organization Name:MEDWARE L L C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:LYNNE
Authorized Official - Last Name:BENNAGE
Authorized Official - Suffix:
Authorized Official - Credentials:DMEPOS
Authorized Official - Phone:248-808-1768
Mailing Address - Street 1:1961 HENRIETTA ST
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:MI
Mailing Address - Zip Code:48009-4169
Mailing Address - Country:US
Mailing Address - Phone:248-808-1768
Mailing Address - Fax:248-258-9173
Practice Address - Street 1:912 S OLD WOODWARD AVE
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:MI
Practice Address - Zip Code:48009-6721
Practice Address - Country:US
Practice Address - Phone:248-647-3200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies