Healthcare Provider Details

I. General information

NPI: 1720268055
Provider Name (Legal Business Name): SELF CARE MEDICAL EQUIPMENT INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2007
Last Update Date: 02/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2505 ORCHARD LAKE RD
SYLVAN LAKE MI
48320-1535
US

IV. Provider business mailing address

2505 ORCHARD LAKE RD
SYLVAN LAKE MI
48320-1535
US

V. Phone/Fax

Practice location:
  • Phone: 248-850-2018
  • Fax: 248-786-3370
Mailing address:
  • Phone: 248-850-2018
  • Fax: 248-786-3370

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. ADAM MOY
Title or Position: PRESIDENT/CEO
Credential:
Phone: 248-850-2018