MEDICARE: REDEMPTIVE MEDICAL EQUIPMENT ,LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332BC3200X	Customized Equipment (DME)

General Provider Information

NPI Number	:	1548933690
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REDEMPTIVE MEDICAL EQUIPMENT ,LLC

Provider Business Mailing Address
First Line	:	30550 GRATIOT AVE UNIT 247
Second Line	:
City	:	ROSEVILLE
State	:	MI
Zip	:	48066-6710
Country	:	US
Telephone Number	:	586-498-7900
Fax Number	:	877-218-4462

Provider Business Practice Location Address
First Line	:	10970 S CLEVELAND AVE STE 601
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33907-2346
Country	:	US
Telephone Number	:	877-498-7903
Fax Number	:	877-218-4462

Authorized Official
Title or Position	:	BILLING
Name	:	ANGIE DUNN
Credential	:
Telephone Number	:	586-498-7900

Provider Enumeration Date	:	07/26/2021
Last Update Date	:	07/26/2021

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