Provider Demographics
NPI:1982612693
Name:FUSION CUSTOM CHAIRS, LLC
Entity Type:Organization
Organization Name:FUSION CUSTOM CHAIRS, LLC
Other - Org Name:FUSION MEDICAL SUPPLIES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NICK
Authorized Official - Middle Name:
Authorized Official - Last Name:LONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-894-5906
Mailing Address - Street 1:1607 PRAIRIE STREET
Mailing Address - Street 2:
Mailing Address - City:ESSEXVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48732-1445
Mailing Address - Country:US
Mailing Address - Phone:989-894-5906
Mailing Address - Fax:989-509-5950
Practice Address - Street 1:1607 PRAIRIE ST
Practice Address - Street 2:
Practice Address - City:ESSEXVILLE
Practice Address - State:MI
Practice Address - Zip Code:48732-1445
Practice Address - Country:US
Practice Address - Phone:989-402-1966
Practice Address - Fax:989-341-3333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-04
Last Update Date:2023-08-23
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
IN200284610AMedicaid
MI874717695Medicaid
IN200284610AMedicaid