Healthcare Provider Details

I. General information

NPI: 1952480220
Provider Name (Legal Business Name): MICHIGAN STATE UNIVERSITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 06/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

463 E CIRCLE DR OLIN HEALTH CENTER - DME
EAST LANSING MI
48824-7500
US

IV. Provider business mailing address

804 SERVICE RD SUITE A202F
EAST LANSING MI
48824-7015
US

V. Phone/Fax

Practice location:
  • Phone: 517-353-9165
  • Fax: 517-432-0709
Mailing address:
  • Phone: 517-355-3503
  • Fax: 517-432-3928

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: KAREN L. ROMIG
Title or Position: PROVIDER ENROLLMENT
Credential:
Phone: 517-884-2976