Basic Information
Provider Information | |||||||||
NPI: | 1225684723 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | MEDICAL SERVICE COMPANIES | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 24000 BROADWAY AVE | ||||||||
Address2: |   | ||||||||
City: | OAKWOOD VILLAGE | ||||||||
State: | OH | ||||||||
PostalCode: | 441466329 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4402323000 | ||||||||
FaxNumber: | 4402323411 | ||||||||
Practice Location | |||||||||
Address1: | 18750 FORT ST APT 20 | ||||||||
Address2: |   | ||||||||
City: | RIVERVIEW | ||||||||
State: | MI | ||||||||
PostalCode: | 481937407 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2487439100 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 08/12/2019 | ||||||||
LastUpdateDate: | 03/28/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | BUNN | ||||||||
AuthorizedOfficialFirstName: | JUDITH | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | COMPLIANCE MANAGER | ||||||||
AuthorizedOfficialTelephone: | 4402323000 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | Y | ||||||||
ParentOrganizationLBN: | MEDICAL SERVICE COMPANIES | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 03/28/2022 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X |   |   | N |   | Suppliers | Durable Medical Equipment & Medical Supplies |   | 332BX2000X |   |   | Y |   | Suppliers | Durable Medical Equipment & Medical Supplies | Oxygen Equipment & Supplies |
No ID Information.