Healthcare Provider Details

I. General information

NPI: 1538354550
Provider Name (Legal Business Name): DOWNRIVER MEDICAL SUPPIES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18025 FORT ST STE C
RIVERVIEW MI
48193-7432
US

IV. Provider business mailing address

18025 FORT ST STE C
RIVERVIEW MI
48193-7432
US

V. Phone/Fax

Practice location:
  • Phone: 734-225-7171
  • Fax: 734-225-7178
Mailing address:
  • Phone: 734-225-7171
  • Fax: 734-225-7178

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MR. TIMOTHY DUNATCHIK
Title or Position: PRESIENT
Credential:
Phone: 734-225-7171