Healthcare Provider Details

I. General information

NPI: 1881623627
Provider Name (Legal Business Name): PHOENIX MEDICAL SUPPLY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2006
Last Update Date: 09/06/2026
Certification Date: 09/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40000 GRAND RIVER AVE STE 306
NOVI MI
48375-2137
US

IV. Provider business mailing address

23370 COMMERCE DR STE 2
FARMINGTON HILLS MI
48335-2726
US

V. Phone/Fax

Practice location:
  • Phone: 248-354-5200
  • Fax: 248-354-9638
Mailing address:
  • Phone: 248-354-5200
  • Fax: 248-354-9638

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number06819C
License Number StateMI

VIII. Authorized Official

Name: MS. LILLIE M NORRIS
Title or Position: OWNER
Credential:
Phone: 248-354-5200