Healthcare Provider Details

I. General information

NPI: 1013335769
Provider Name (Legal Business Name): 3RD ST MEDICAL SUPPLY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2014
Last Update Date: 10/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 RENSEN ST STE D
LANSING MI
48910-3669
US

IV. Provider business mailing address

1501 RENSEN ST STE D
LANSING MI
48910-3669
US

V. Phone/Fax

Practice location:
  • Phone: 714-988-6585
  • Fax:
Mailing address:
  • Phone: 714-988-6585
  • 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: NOHA M ABDELLATIF
Title or Position: CEO
Credential:
Phone: 714-988-6585