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General NPI Number Information
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NPI Number | 1588282842
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Entity Type | Organization
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Legal Business Name | MICHIANA MEDICAL SUPPLY LLC
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Dates
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Enumeration Date | 07/13/2020
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Last Update Date | 05/14/2021
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Provider Practice Location Address
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Address Line | 1509 W JOHN BEERS RD STE A&B
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City | STEVENSVILLE
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State | MI
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Zip | 49127-9408
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Country | US
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Telephone | 269-932-4765
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Fax | 269-621-6110
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Provider Business Mailing Address
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Address Line | 1509 W JOHN BEERS RD STE A&B
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City | STEVENSVILLE
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State | MI
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Zip | 49127-9408
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Country | US
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Telephone | 269-932-4765
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Fax |
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | KARMEN ANN BROWER
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Credential |
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Telephone | 269-313-2370
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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