Healthcare Provider Details

I. General information

NPI: 1619266491
Provider Name (Legal Business Name): ZYLSTRA MEDICAL SUPPLY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2011
Last Update Date: 09/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1998 44TH ST SE
KENTWOOD MI
49508-5049
US

IV. Provider business mailing address

1998 44TH ST SE
KENTWOOD MI
49508-5049
US

V. Phone/Fax

Practice location:
  • Phone: 616-827-9290
  • Fax:
Mailing address:
  • Phone: 616-827-9290
  • Fax:

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: MR. BRIAN F ZYLSTRA
Title or Position: PRESIDENT
Credential:
Phone: 616-827-9290